Kjirsten Broughton, CCC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

5516 S Fort Apache Rd Ste 130
Las Vegas, NV 89148-7679

Phone

(702) 641-8255

NPI assigned

May 22, 2017

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

Other names 1

• Kjirsten Kroenke Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495411200000",
    "number": "1326575283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43089 E BIG MCDONALD DR",
            "city": "DENT",
            "state": "MN",
            "postal_code": "565289134",
            "telephone_number": "907-414-7058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5516 S FORT APACHE RD STE 130",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891487679",
            "telephone_number": "702-641-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUGHTON",
        "first_name": "KJIRSTEN",
        "credential": "CCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-22",
        "last_updated": "2017-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KJIRSTEN",
            "last_name": "KROENKE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ally Brotherson
• Erin C Brotherton, PHARM.D., CGP
• Steven Brotman, B.S., M.S.
• Tamika Rashael Brouchet
• Timise Brough, FNP
• Talitha Renee Kincade Broughton
• Cheryl Baker Broussard, APN
• Janae Broussard, LPN
• Jonathon Broussard
• Kimberly R Broussard

• Speech-Language Pathologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Speech-Language Pathologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2017; 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.