Active NPI
Romona Broussard Mayeux, FNP-BC
- Family Nurse Practitioner
- Jackson, MS
National Provider Identifier
1437151636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R881289
- Practice address
- 248 E Capitol St
Room 105
Jackson, MS 39201-2503 - Phone
- (601) 714-2563
- Fax
- (601) 510-4653
- NPI assigned
- Jun 1, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN041380 AP01824 | LA | |
| Family Nurse Practitioner | 363LF0000X | R881289 | MS | Primary |
Addresses
Primary practice location
248 E Capitol St
Room 105
Jackson, MS 39201-2503
Mailing address
248 E Capitol St
Room 105
Jackson, MS 39201-2503
Phone (601) 714-2563
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AP01824 | Other | LA | APN LICENSE NUMBER |
| 1655244 | Medicaid | LA | |
| R881289 | Other | MS | MISSISSIPPI STATES BOARD OF NURSING |
| RN041380 | Other | LA | RN LICENSE NUMBER |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN041380 AP01824 | LA | MD | Family Nurse Practitioner |
| R881289 | MS | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1437151636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 E CAPITOL ST",
"address_2": "ROOM 105",
"city": "JACKSON",
"state": "MS",
"postal_code": "392012503",
"telephone_number": "601-714-2563",
"fax_number": "601-510-4653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 E CAPITOL ST",
"address_2": "ROOM 105",
"city": "JACKSON",
"state": "MS",
"postal_code": "392012503",
"telephone_number": "601-714-2563",
"fax_number": "601-510-4653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYEUX",
"first_name": "ROMONA",
"middle_name": "BROUSSARD",
"name_prefix": "Ms.",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-01",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "LA",
"license": "RN041380 AP01824",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "R881289",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "APN LICENSE NUMBER",
"identifier": "AP01824",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1655244",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSISSIPPI STATES BOARD OF NURSING",
"identifier": "R881289",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE NUMBER",
"identifier": "RN041380",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.