NPI 1265034516
Shanika Broussard
Practice location
- Address
- 6163 E Lamar St, Bay Saint Louis, MS 39520-8267
- Phone
- (504) 908-5893
- Mailing address
- 1110 Cowan Rd. Suite B #2014, Gulfport, MS 39507
Registered specialties
Adult Companion
Primary
Registry record
- NPI
- 1265034516
- Entity type
- Individual
- Sex (as registered)
- Female
- NPI issued
- 11 Nov 2020
- Record last updated
- 11 Nov 2020
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.