Active NPI
Bianca Simone Broughton, LAT, ATC, EMT
- Athletic Trainer
- Dallas, TX
National Provider Identifier
1376936526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT5277
- Practice address
- 2355 Duncanville Rd
Dallas, TX 75211-6532 - Phone
- (281) 772-2210
- NPI assigned
- Mar 12, 2015
- Last updated
- Dec 8, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2481 | NC | |
| Athletic Trainer | 2255A2300X | AT5277 | TX | Primary |
Addresses
Primary practice location
2355 Duncanville Rd
Dallas, TX 75211-6532
Mailing address
2500 Warren Carroll Dr
Raleigh, NC 27695
Phone (919) 515-2111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2481 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| AT5277 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670457600000",
"number": "1376936526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 WARREN CARROLL DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27695",
"telephone_number": "919-515-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2355 DUNCANVILLE RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752116532",
"telephone_number": "281-772-2210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUGHTON",
"first_name": "BIANCA",
"middle_name": "SIMONE",
"name_prefix": "Ms.",
"credential": "LAT, ATC, EMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-12",
"last_updated": "2022-12-08",
"certification_date": "2022-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "2481",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT5277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
- Brothers & Crochet OBGYN Associates of Dallas LLP
- Sandra Zoe Brothers, M.D.
- Randall James Brotherton
- Maya Sandra Brouette
- Jonathan Reeves Brough, M.D.
- Kirbie Danielle Broughton, MD
- Kristen Broughton, MD
- Michelle Leigh Brouillard, MPT
- Michael A. Brouillette, PHYSICIAN ASSISTANT
- Sara D Brouse, PHARM.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.