Active NPI
Kieron Renard Broomsey, LCM
- Case Manager/Care Coordinator
- Shreveport, LA
National Provider Identifier
1194279471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1434 Hawn Ave
Shreveport, LA 71107 - Phone
- (318) 422-4459
- NPI assigned
- Aug 4, 2016
- Last updated
- May 21, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | LA | Primary |
Addresses
Primary practice location
1434 Hawn Ave
Shreveport, LA 71107
Mailing address
1820 Benton Road
Bossier City, LA 71111
Phone (318) 422-4459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526860800000",
"number": "1194279471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1820 BENTON ROAD",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "71111",
"telephone_number": "318-422-4459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1434 HAWN AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71107",
"telephone_number": "318-422-4459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOMSEY",
"first_name": "KIERON",
"middle_name": "RENARD",
"name_prefix": "Mr.",
"credential": "LCM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-04",
"last_updated": "2018-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "LA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.