Gwendolyn Broyles, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2017008864 Issued in MO

Practice address

840 Passover Rd
Osage Beach, MO 65065-2834

Phone

(573) 302-0319

NPI assigned

May 12, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Osage Beach Center for Behavioral Health, LLCGroup PAC ID 2062649288, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Osage Beach Center for Behavioral Health, LLC

  • Psychiatric Hospital
  • Osage Beach, MO
  • NPI 1790115939

  MO

  Medicare reassignment Care Compare group
• Hope Connections, LLC

  • Professional Counselor
  • Waynesville, MO
  • NPI 1548686066

  MO

  Medicare reassignment NPD
• Lake Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Osage Beach, MO
  • NPI 1366037764

  MO

  Medicare reassignment NPD
• Magers Family Health and Wellness Center

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1073600334

  MO

  Medicare reassignment NPD
• Serenity Health LLC

  • Psychiatry Physician
  • Saint Peters, MO
  • NPI 1104569151

  MO

  Medicare reassignment NPD
• Lake Behavioral Health Associates, LLC

  • Clinical Psychologist
  • Osage Beach, MO
  • NPI 1942241203
  NPD
• St. Louis Internal Medicine Inc

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1104856442
  NPD (past)

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

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1497282008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 PASSOVER RD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650652834",
            "telephone_number": "573-302-0319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 PASSOVER RD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650652834",
            "telephone_number": "573-302-0319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROYLES",
        "first_name": "GWENDOLYN",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-12",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0810X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Family",
            "state": "MO",
            "license": "2016032658",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2017008864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Brayfield, DO
• Angela J Breckenridge, DO
• Joshua Palmer Brickner, D.O.
• Darla Lasters Brown, CRNA
• Sarah Elizabeth Brown, MPT
• Audrey Dane Bruemmer, COTA/L
• Teresa R Buol, APRN, MSN, FNP-C
• Kelsey Jo Burge, M.S. CCC-SLP
• Chelsea Danielle Burke
• Kristina Kay Burton, FNP

• All providers in Osage Beach, MO
• Psychiatric/Mental Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.