NPIMap

Individual provider Active NPI

Jamilia Lashawn Broussard, MSN RN FNP-BC WCC

  • Family Nurse Practitioner
  • Ardmore, OK
National Provider Identifier
1184122145
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP136689 Issued in TX
Practice address
1001 12TH Ave NW
Ardmore, OK 73401-5712
Phone
(580) 220-6290
Fax
(580) 220-6215
NPI assigned
Jan 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 821209 TX
Family Nurse Practitioner 363LF0000X AP136689 TX Primary

Addresses

Primary practice location

1001 12TH Ave NW
Ardmore, OK 73401-5712

Mailing address

PO Box 678219
Dallas, TX 75267-8219
Phone (214) 970-6817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210614001748 TX Practitioner - Nurse Practitioner 6800144916 Reassigns benefits to 1 organization
I20220805000516 NC Practitioner - Nurse Practitioner 6800144916 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Wound Specialists of North Carolina, PLLCGroup PAC ID 7810172616, 17 clinicians

Practice addresses (Care Compare)

35 Memorial Dr
Pinehurst, NC 28374-8708
Phone (910) 715-5901

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
821209TXMDFamily Nurse Practitioner
AP136689TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Chma of NC CurrentSince Aug 15, 2022 Accepting new patients
Integrated Wound Specialists of North Carolina, PLLC Nurse Practitioner CurrentSince Jul 24, 2023 Accepting new patients
Consonant Healing Associates of de LLC Nurse Practitioner CurrentSince Nov 4, 2022 Accepting new patients
FHPG, LLC Past Accepting new patients

Locations

909 Ridgebrook Rd
Ste 300
Sparks Glencoe, MD 21152
Phone (443) 483-9300

6047 Tyvola Glen Cir
Charlotte, NC 28217
Phone (203) 238-7754

35 Memorial Dr
Pinehurst, NC 28374
Phone (910) 715-3376

155 Memorial Dr
Pinehurst, NC 28374
Phone (910) 215-1000

6322 Fayetteville Rd
Raeford, NC 28376
Phone (910) 878-6700

925 S Long Dr
Rockingham, NC 28379
Phone (910) 417-3000

12830 Hillcrest Rd
Ste 111
Dallas, TX 75230
Phone (972) 964-9087

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jbroussard115940@firsthealth.direct-ci.net
  • Direct secure messaging: jroussard988904@directc.mercy.net

Organizations & group practices 4

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.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1184122145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 678219",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752678219",
            "telephone_number": "214-970-6817",
            "fax_number": "844-803-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015712",
            "telephone_number": "580-220-6290",
            "fax_number": "580-220-6215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "JAMILIA",
        "middle_name": "LASHAWN",
        "name_prefix": "Mrs.",
        "credential": "MSN RN FNP-BC WCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-24",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "821209",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP136689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.