Individual provider Active NPI

Shaquinta Broussard, RN

  • Registered Nurse
  • Las Vegas, NV
National Provider Identifier
1205745882
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
811117 Issued in NV
Practice address
3930 Howard Hughes Pkwy Ste 300
Las Vegas, NV 89169-0946
Phone
(702) 560-2192
NPI assigned
Sep 1, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 811117 NV Primary

Addresses

Primary practice location

3930 Howard Hughes Pkwy Ste 300
Las Vegas, NV 89169-0946

Mailing address

511 Claxton Ave
North Las Vegas, NV 89084-1248
Phone (424) 757-7662

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1788220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1205745882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 CLAXTON AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890841248",
            "telephone_number": "424-757-7662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 HOWARD HUGHES PKWY STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891690946",
            "telephone_number": "702-560-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "SHAQUINTA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-09-01",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NV",
            "license": "811117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.