Michelle Louise Broughton, APRN
Individual provider Active NPI Nurse Practitioner · Barbourville, KY
NPI 1053540674 · NPPES record last updated Dec 8, 2020
Key facts
- NPI
- 1053540674
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 3006067 (KY)
- Practice address
- 602 Knox St
Barbourville, KY 40906-1304 - Phone
- (606) 546-6027
- Fax
- (606) 546-2084
- NPI assigned
- Jul 2, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- B and G
Practice addresses (Care Compare)
14 Knox Plaza
Barbourville, KY 40906-7300
14 Knox PLZ
Barbourville, KY 40906-7300
Phone (606) 627-5564
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Yahweh Medical Clinic Barbourville |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) Corporate Officer Corporate Director W-2 Managing Employee |
Jun 22, 2021 Jun 22, 2021 Jun 22, 2021 Jun 22, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090923000175 | KY | Practitioner - Nurse Practitioner | 5799831343 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3006067 | KY | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| B & G | Current |
Accepting new patients | |
| Physicians Express Care Billing | Past | Accepting new patients |
Locations
215 Treuhaft Blvd
Ste 2
Barbourville, KY 40906
Phone (606) 545-0400
14 Knox Plz
Barbourville, KY 40906
Phone (606) 627-5564
10755 N US Highway 25E
Gray, KY 40734
Phone (606) 215-1793
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 3006067 | KY | Yes |
Addresses
Primary practice location
602 Knox St
Barbourville, KY 40906-1304
Mailing address
PO Box 1325
Corbin, KY 40702-1325
Phone (606) 526-8131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100100740 | Medicaid | KY | |
| P01432838 | Other | KY | RR MCR |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mbroughton4832@bhkydirect.com |
Other providers in Barbourville, KY
- Kristen Nicole Bowling
- Ron Christopher Bowling
- Douglas Branch
- Brent Barrett Inc
- Lauren Brooks
- Sarah Michelle Brown
- Teresa Tracyann Brown
- Clay Butler
- Carolyn Disney Byble
- Rebekah Susan Cain
All providers in Barbourville, KY · Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.