Kimberly Lauren Broussard
Individual provider Active NPI Rehabilitation Practitioner · Willows, CA
NPI 1073244752 · NPPES record last updated Sep 9, 2025
Key facts
- NPI
- 1073244752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rehabilitation Practitioner 225400000X
- Practice address
- 242 N Villa Ave
Willows, CA 95988-2641 - Phone
- (530) 934-6582
- NPI assigned
- Jun 22, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Rehabilitation Practitioner | 225400000X | Yes |
Addresses
Primary practice location
242 N Villa Ave
Willows, CA 95988-2641
Mailing address
242 N Villa Ave
Willows, CA 95988-2641
Phone (530) 934-6582
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1709 | Other | MEDICAL |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kbroussard@countyoflgenn.net | Direct |
Other providers in Willows, CA
- Anne Frances Bonesio
- Braydon Bouwhuis
- William Boyes
- Marc Steven Bracy
- Dedra Ann Brooks
- Shelby Rae Bruce
- Maxwel Joseph Bryant
- Denbeigh Lee Burgess
- Jose Alejandro Calderon
- California Em-I Medical Services a Medical Corporation
All providers in Willows, CA · Rehabilitation Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.