NPI 1477908275

Kimberly Broussard

Organisation Preferred Provider Organization Las Vegas, NV

Practice location

Address: 3380 E Russell Rd Suite 104, Las Vegas, NV 89120-3402
Phone: (702) 476-0448
Fax: (702) 476-0449

Authorised official

Name: Kimberly Rashone Broussard
Title: Owner / Operator
Phone: (702) 807-1718

Registered specialties (2)

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

Other Preferred Provider Organization providers in Nevada →

Behavior Analyst

Behavioral Health & Social Service Providers Taxonomy 103K00000X

Other Behavior Analyst providers in Nevada →

Registry record

NPI: 1477908275
Entity type: Organization
NPI issued: 28 Apr 2016
Record last updated: 29 Apr 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.