Jo Dee Goodeaux Broussard, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA200320 Issued in LA

Practice address

108 Rue Louis Xiv
Lafayette, LA 70508-5739

Phone

(337) 235-8007

Fax

(855) 270-5479

NPI assigned

Nov 4, 2009

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507248000000",
    "number": "1578890190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 RUE LOUIS XIV",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-235-8007",
            "fax_number": "855-270-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 RUE LOUIS XIV",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-235-8007",
            "fax_number": "855-270-5479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1455 E Bert Kouns Loop",
            "address_2": "Suite #210",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055634",
            "country_code": "US",
            "telephone_number": "318-798-4623",
            "fax_number": "318-798-4646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODEAUX BROUSSARD",
        "first_name": "JO",
        "middle_name": "DEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-04",
        "last_updated": "2017-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA200320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1808181",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marvida Gonsoulin-Harris, RN
• Amber Gonsoulin, SLP
• Carl B Gonsoulin, D.D.S.
• Douglas M Gonzales, M.D.
• Renee Gabriella Gonzalez
• Macy Goodness, LPC
• Goodwill Industries of Acadiana, Inc.
• Goodwill Industries of Acadiana, Inc.
• Lindsey R Goodyear, NP
• Bhavya H Gopalagowda, M.D.

• Physician Assistant in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; 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.