Kristen Broaddus, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP130855 Issued in TX

Practice address

1051 Pineloch Dr
#600
Houston, TX 77062

Phone

(281) 990-9979

Fax

(281) 990-9916

NPI assigned

Aug 28, 2016

Last updated

Aug 28, 2016By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472342400000",
    "number": "1386190619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 PINELOCH DR",
            "address_2": "#600",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77062",
            "telephone_number": "281-990-9979",
            "fax_number": "281-990-9916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 PINELOCH DR",
            "address_2": "#600",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77062",
            "telephone_number": "281-990-9979",
            "fax_number": "281-990-9916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADDUS",
        "first_name": "KRISTEN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP130855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Houston, TX
• Providers in Houston, 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 Aug 28, 2016; 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.