Andrea Broussard

Primary specialty

Home Health AideTaxonomy code 374U00000X

Practice address

406 Pass Rd
Gulfport, MS 39507

Phone

(286) 699-8402

NPI assigned

Jan 9, 2017

Last updated

Feb 1, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548979200000",
    "number": "1538605027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 PASS RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395072901",
            "telephone_number": "286-699-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 PASS RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39507",
            "telephone_number": "286-699-8402"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "406 Pass Rd",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "39507",
            "country_code": "US",
            "telephone_number": "286-699-8402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "ANDREA",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-09",
        "last_updated": "2019-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "MS",
            "license": null,
            "primary": true
        },
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104736701",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kali Brooks
• Reggie Harris Broom, DMD
• Cathy Broome, PHARMACIST
• Courtney L Broome, OT
• Tiffany Brosh, N.P.
• Curtis A Broussard, MD
• Alicia Brown, M.ED
• Allison C. Brown, CCC-SP
• Darien Brown, RBT
• Ebony Brown

• Home Health Aide in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Home Health Aide in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; 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.