Drake Broadbent, REGISTERED NURSE

Primary specialty

Wound Care Registered NurseTaxonomy code 163WW0000X

License

6603242-3102 Issued in UT

Practice address

2019 E Riverside Dr
St George, UT 84790-8134

Phone

(801) 376-0330

NPI assigned

Mar 29, 2023

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1568166940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 MADISON AVE",
            "city": "SANTA CLARA",
            "state": "UT",
            "postal_code": "847655642",
            "telephone_number": "801-376-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 E RIVERSIDE DR",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908134",
            "telephone_number": "801-376-0330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Santa Clara",
            "state": "UT",
            "postal_code": "847655642",
            "country_code": "US",
            "telephone_number": "801-376-0330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROADBENT",
        "first_name": "DRAKE",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-29",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "UT",
            "license": "6603242-3102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derry L Brinley, D.O.
• Thomas S Brinton, MD
• Keith Anthony Britt, MD
• Alberto Antonio Brizolara, M.D.
• Cora Ann Broadbear, NP
• Holly Broadbent
• Lacey Broadbent
• Alexa Brandie Brock
• Virgil W. Brockbank, PH.D.
• Jillian Broeckert, LCMHC

• Wound Care Registered Nurse in St George, UT
• Providers in St George, UT by specialty
• Wound Care Registered Nurse in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.