Individual
TERRY LEE BROADBENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
3901 RAINBOW BLVD, DEPARTMENT OF NURSING, KANSAS CITY, KS 66160-0001
(913) 588-7832
Mailing address
3901 RAINBOW BLVD, DEPARTMENT OF NURSING SERVICES, KANSAS CITY, KS 66160-0001
(913) 588-7832
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
13-69014-121
KS
363L00000X
Nurse Practitioner
Primary
45612
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13-69014-121
RN LICENSE
KS
01
—
45612
ARNP LICENSE
KS
Enumeration date
06/15/2007
Last updated
07/08/2007
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