Emma Marie Broussard, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

1047924 Issued in TX

Practice address

2201 Clear Creek Rd
Killeen, TX 76549-4110

Phone

(281) 904-3118

NPI assigned

Jul 20, 2021

Sex

Female

Sole proprietor

No

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

Enrolled in WA

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Medical Specialties PLLCGroup PAC ID 8022903384, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Northwest Medical Specialties PLLC

  • Multi-Specialty Clinic/Center
  • Tacoma, WA
  • NPI 1548261308
  Medicare reassignment Care Compare group NPD
• Northwest Medical Specialties Pharmacy

  • Clinic Pharmacy
  • Tacoma, WA
  • NPI 1053489062
  NPD (past)

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1306419015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901A SPICEWOOD SPRINGS RD STE 201",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787598728",
            "telephone_number": "377-226-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 CLEAR CREEK RD",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765494110",
            "telephone_number": "281-904-3118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "EMMA",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-07-20",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1047924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth J Brock, D.O.
• Amanda Jane Brokke, CRNA
• Zoe Grace Bronwasser, RBT
• Jasmine Lee Brooks
• Jeffrey A Brooks, PA-C
• Elizabeth Brown-Miller, BCBA, LBA
• Christian Elijah Brown
• Eleanor Lewis Brown, LPC
• Halie Brown
• Madeline Brown

• Gerontology Nurse Practitioner in Killeen, TX
• Providers in Killeen, TX by specialty
• Gerontology Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.