Philip Brandon Broussard I, CIT

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

CIT-5418 Issued in LA

Practice address

7330 Fern Ave Ste 1003
Shreveport, LA 71105-4988

Phone

(318) 550-5490

Fax

(318) 550-5489

NPI assigned

Jan 10, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1704844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1285405159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7330 FERN AVE STE 1003",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054988",
            "telephone_number": "318-550-5490",
            "fax_number": "318-550-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7330 FERN AVE STE 1003",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054988",
            "telephone_number": "318-550-5490",
            "fax_number": "318-550-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "PHILIP",
        "middle_name": "BRANDON",
        "name_suffix": "I",
        "credential": "CIT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "LA",
            "license": "CIT-5418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andre Paul Broussard, MD
• Brittany Jean Broussard, CIT
• Daryn Broussard, LPC
• Jason Broussard, D.O.
• Marlene Marie Broussard, M.D.
• Sherry Broussard, MA
• Misty Brower
• Sherita Prelow Brown-Mims, LPC
• Rukiya Brown-Williams, LPC, LAC, LMHP
• Alesia Brown

• All providers in Shreveport, LA
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.