Jacob Paul Broussard, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

ATH.200192 Issued in LA

Practice address

808 S Broadway St
Erath, LA 70533-4014

Phone

(337) 937-8451

NPI assigned

Jun 1, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1184248684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 PEAR TREE CIR",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705187237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 S BROADWAY ST",
            "city": "ERATH",
            "state": "LA",
            "postal_code": "705334014",
            "telephone_number": "337-937-8451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "JACOB",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-01",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "LA",
            "license": "ATH.200192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Injurefree",
            "affiliation": "N",
            "address_1": "808 S Broadway St",
            "city": "Erath",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705334014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Scotty Paul Broussard, PHARMACIST
• Cashway Pharmacy of Erath L.L.C.
• D and L Family Drug Store
• Erath Family Doctor Clinc, Inc
• Erath RX Inc

• Athletic Trainer in Erath, LA
• Providers in Erath, LA by specialty
• Athletic Trainer in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; 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.