Melissa Southall Broome, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

220005 Issued in MS

Practice address

2222 S Frontage Rd
Vicksburg, MS 39180-5271

Phone

(601) 852-3271

NPI assigned

Sep 3, 2019

Sex

Female

Sole proprietor

No

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

• Vicksburg Center for Exceptional Children

  • Behavior Analyst
  • Vicksburg, MS
  • NPI 1063226678
  NPD Authorized official
• Jubilee Therapy, LLC

  • Speech-Language Pathologist
  • Vicksburg, MS
  • NPI 1417434986
  NPD (past)
• Spectrum Academy

  • Clinic/Center
  • Jackson, MS
  • NPI 1215572581
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 24, 2022.

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1053969097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 S FRONTAGE RD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805271",
            "telephone_number": "601-218-5497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 S FRONTAGE RD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805271",
            "telephone_number": "601-852-3271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOME",
        "first_name": "MELISSA",
        "middle_name": "SOUTHALL",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-03",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MS",
            "license": "220005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Brent
• Laura Jeanne Briggs, PT
• Kara Brister
• Anna Jeanette Britt, RN
• Pamela Brookins
• Tiffany Brown Alexander
• Ashley Brown
• Deborah Brown
• James Brown
• Kristen Brown

• All providers in Vicksburg, MS
• Behavior Analyst in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.