Shana Marie Broussard
Individual provider Active NPI Family Nurse Practitioner · Vancleave, MS
NPI 1134740798 · NPPES record last updated Jun 24, 2020
Key facts
- NPI
- 1134740798
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 903748 (MS)
- Practice address
- 10404 Tucker Rd # LLC
Vancleave, MS 39565-7922 - Phone
- (228) 354-9505
- NPI assigned
- May 5, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ocean Springs Urgent Care
Coastal Family Health Center, Inc
Practice addresses (Care Compare)
1514 Bienville Blvd
Ocean Springs, MS 39564-3006
Phone (228) 382-9222
23453 Central Dr
Saucier, MS 39574-7521
Phone (228) 832-7223
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200629003038 | MS | Practitioner - Nurse Practitioner | 1355763871 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 903748 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gulfport 49 Imaging, LLC | Current |
Accepting new patients | |
| Coastal Family Health Center, Inc | Current |
Accepting new patients | |
| Coastal Family Health Center, Inc | Current | Accepting new patients | |
| Pascagoula Urgent Care | Current |
Accepting new patients | |
| Orange Grove Urgent Care | Current |
Accepting new patients | |
| Maxem Health Urgent Care Diberville | Current |
Accepting new patients | |
| Ocean Springs Urgent Care | Current |
Accepting new patients | |
| Coastal Family Health Center, Inc | Current |
Accepting new patients | |
| Cavalier County Memorial Hospital Association | Past | Accepting new patients |
Locations
715A Division St
Biloxi, MS 39530
Phone (228) 374-4991
1046 Division St
Biloxi, MS 39530
Phone (225) 374-2494
10319 Diberville Blvd
Diberville, MS 39540
Phone (228) 395-2999
10556 Highway 49
Gulfport, MS 39503
Phone (228) 539-2399
1514 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 382-9222
2210 Denny Ave
Pascagoula, MS 39567
Phone (228) 372-6040
Interoperability endpoints
- sbroussard@direct.mhg.com
- shana.broussard.p1@direct.cfhc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 903748 | MS | Yes |
Addresses
Primary practice location
10404 Tucker Rd # LLC
Vancleave, MS 39565-7922
Mailing address
4511 Lynn Dr
Biloxi, MS 39532-9477
Phone (228) 860-1773
Other providers in Vancleave, MS
- Bienville Orthopaedic Specialists, LLC
- Bienville Surgery Center, LLC
- Bienville Therapy, LLC
- Lennon E. Bowen IV
- Elizabeth Louise Boyle
- Sarah Burke
- Christopher Burks
- Burnham Drugs No. 4 LLC
- Burnham-McKinney Pharmacy No 4 LLC
- Karen Veronica Carlisle-Bond
All providers in Vancleave, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 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.
- 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.