Lakeesha Sumone Broughton-Nelson, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Montgomery, AL
NPI 1134855992 · NPPES record last updated Nov 3, 2022
Key facts
- NPI
- 1134855992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 1-164831 (AL)
- Practice address
- 233 Winton Blount Loop
Montgomery, AL 36117-3507 - Phone
- (334) 239-2622
- NPI assigned
- Jul 25, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Gardenia Cove Mental Health PC
Practice addresses (Care Compare)
7475 Halcyon Pointe Dr
Montgomery, AL 36117-8053
Phone (334) 954-6010
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- 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 |
|---|---|---|---|---|
| I20221109002692 | AL | Practitioner - Nurse Practitioner | 3476920166 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-164831 | AL | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gardenia Cove Mental Health PC | Current |
Accepting new patients | |
| River Region Psychiatry Associates LLC | Current |
Accepting new patients |
Locations
1000 1st St N
Alabaster, AL 35007
Phone (205) 620-8100
233 Winton M Blount Loop
Montgomery, AL 36117
Phone (334) 207-3188
7475 Halcyon Pointe Dr
Montgomery, AL 36117
Phone (334) 954-6010
333 Business Cir
Pelham, AL 35124
Phone (205) 255-3828
1776 Independence Ct
Ste 302
Vestavia Hills, AL 35216
Phone (205) 506-0322
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 1-164831 | AL | Yes |
Addresses
Primary practice location
233 Winton Blount Loop
Montgomery, AL 36117-3507
Mailing address
233 Winton Blount Loop
Montgomery, AL 36117-3507
Phone (334) 239-2622
Other providers in Montgomery, AL
- Heather Lee Brooks
- Janaiya Leshae Brooks
- Radinka Brooks
- Shija Brooks
- Vicki Brooks
- Heather Amelia Broussard Lawson
- Larry Fulton Browder
- Brown Counseling, LLC
- Tangilyn La'Toya Brown Washington
- Alyasa Brown
All providers in Montgomery, AL · Psychiatric/Mental Health Nurse Practitioner in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2022. 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.