Active NPI
Catherine Boudreaux Broussard, M.D.
- Pediatrics Physician
- Youngsville, LA
National Provider Identifier
1710121702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 205001
- Practice address
- 1512 Chemin Metairie Rd
Suite B
Youngsville, LA 70592-5382 - Phone
- (337) 704-7047
- NPI assigned
- Apr 22, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 205001 | LA | Primary |
Addresses
Primary practice location
1512 Chemin Metairie Rd
Suite B
Youngsville, LA 70592-5382
Mailing address
118 Hospital Dr
Lafayette, LA 70503-2819
Phone (337) 704-7047
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 205001 | LA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Pediatrics of Acadiana, LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479168000000",
"number": "1710121702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 HOSPITAL DR",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705032819",
"telephone_number": "337-704-7047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1512 CHEMIN METAIRIE RD",
"address_2": "SUITE B",
"city": "YOUNGSVILLE",
"state": "LA",
"postal_code": "705925382",
"telephone_number": "337-704-7047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "CATHERINE",
"middle_name": "BOUDREAUX",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-22",
"last_updated": "2016-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "LA",
"license": "205001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Youngsville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.