Latricia Broaddus

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024181570 Issued in VA

Practice address

5833 Richmond Tappahannock Hwy Ste 106B
Aylett, VA 23009-3007

Phone

(042) 230-0298

NPI assigned

Oct 31, 2018

Last updated

Mar 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Its All About Caring LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Aylett, VA
  • NPI 1548995913
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1003383688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13",
            "city": "SAINT STEPHENS CHURCH",
            "state": "VA",
            "postal_code": "231480013",
            "telephone_number": "804-664-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5833 RICHMOND TAPPAHANNOCK HWY STE 106B",
            "city": "AYLETT",
            "state": "VA",
            "postal_code": "230093007",
            "telephone_number": "042-230-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADDUS",
        "first_name": "LATRICIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-31",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024181570",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0732762767",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan W Biggers III, D.O.
• Blessed by Grace, LLC
• Mary Lynn Booker, NP
• Rachael Nicole Bowling, LDO
• Samone Boyd
• Lily Alemi Cameron, MD
• Central Virginia Health Services Inc (CVHS King William)
• Joanne Lynne Cunningham
• Raven Custalow, AGPCNP-BC
• Jessica D'Aurora, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in Aylett, VA
• Providers in Aylett, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.