Gwendolyn Broughton

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

L14757 Issued in AR

Practice address

5800 W 10TH St
101
Little Rock, AR 72204-1752

Phone

(501) 660-6886

Fax

(501) 660-6838

NPI assigned

May 1, 2011

Last updated

May 1, 2011By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Centers for Youth and Families, Inc.

  • Psychiatric Residential Treatment Facility
  • Little Rock, AR
  • NPI 1174617526
  NPD (past)

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

{
    "created_epoch": "1304208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304208000000",
    "number": "1356632996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1867 S CROSS ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722061056",
            "telephone_number": "501-554-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 W 10TH ST",
            "address_2": "101",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722041752",
            "telephone_number": "501-660-6886",
            "fax_number": "501-660-6838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUGHTON",
        "first_name": "GWENDOLYN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-01",
        "last_updated": "2011-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "L14757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPN",
            "identifier": "L14757",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brookside Health Services
• Brookside Healthcare & Rehab, LLC (Brookside Health and Rehabilitation Center)
• Lee Ann Brosh, M.A, CCC-SLP
• Amber Brossett, LCSW
• Erin Broughton, QBHP
• Christine Beall Broussard, PT, DPT
• Margaret Eleanor Broussard, BCBA
• Sally Browder, PH.D.
• Brown Properties, Inc. (Magnolia Retirement Center)
• Charlis Brown-McKay, QBHP

• Licensed Practical Nurse in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Licensed Practical Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2011; 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.