Jennifer Alison Broussard, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN204586 Issued in GA

Practice address

211 Goose Hollow Rd
Reynolds, GA 31076-3505

Phone

(478) 216-1110

NPI assigned

Jul 5, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Jennifer A Mathis Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Houston County Emergency Group, LLCGroup PAC ID 2264663756, 41 clinicians

Peach Emergency Group LLCGroup PAC ID 2567628993, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
• Direct secure messaging: jennifer.broussard.1@19436.direct.athenahealth.com
• Direct secure messaging: jbroussard2941840@carolinashealthcaresystem.direct-ci.com

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.

• Houston County Emergency Group, LLC

  • Emergency Medicine Physician
  • Warner Robins, GA
  • NPI 1013338193
  Medicare reassignment Care Compare group NPD
• Peach Emergency Group LLC

  • Emergency Medicine Physician
  • Byron, GA
  • NPI 1902165327

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Houston County Emergency Group, LLC

  • Emergency Medicine Physician
  • Perry, GA
  • NPI 1467873547
  NPD
• TLC of Georgia LLC

  • Family Nurse Practitioner
  • Jefferson, GA
  • NPI 1750677241
  NPD
• Urgent Care Center of Central Georgia LLC

  • Urgent Care Clinic/Center
  • Warner Robins, GA
  • NPI 1306241336
  NPD
• Taylor Regional Hospital

  • Pediatrics Physician
  • Hawkinsville, GA
  • NPI 1720339336
  NPD (past)

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1255852851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 GOOSE HOLLOW RD",
            "city": "REYNOLDS",
            "state": "GA",
            "postal_code": "310763505",
            "telephone_number": "478-216-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 GOOSE HOLLOW RD",
            "city": "REYNOLDS",
            "state": "GA",
            "postal_code": "310763505",
            "telephone_number": "478-216-1110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5665 New Northside Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303284617",
            "country_code": "US",
            "telephone_number": "770-874-5400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Galleria Pkwy SE Ste 1300",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303395967",
            "country_code": "US",
            "telephone_number": "800-893-9698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "JENNIFER",
        "middle_name": "ALISON",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-05",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN204586",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN204586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MATHIS",
            "middle_name": "A",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alternative Youth Services, Inc.
• Bridges for Change, Inc.
• Thomas Prier Callier IV, MD
• Ilana Diallo
• Angela Leigh Eubanks, MSN, PMHNP-BC
• Georgia Behavioral Campus LLC
• Georgia Recovery Campus,LLC

• Family Nurse Practitioner in Reynolds, GA
• Providers in Reynolds, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.