Broadway Psychiatry LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BROADWAY PSYCHIATRY LLC

Practice address

3960 Broadway Blvd Ste 232
Garland, TX 75043-2591

Phone

(469) 733-2090

NPI assigned

Jun 24, 2020

Organization subpart

No

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

Authorized official

Name

Velile Sibusisiwe Nkolomi, NP

Title

Ceo

Phone

(469) 733-2090

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Velile Sibusisiwe Nkomo, DNP PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Garland, TX
  • NPI 1487165965
  Medicare reassignment

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594425600000",
    "number": "1750907879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2657 JOHNSON CT",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751261696",
            "telephone_number": "469-733-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 BROADWAY BLVD STE 232",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750432591",
            "telephone_number": "469-733-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-24",
        "last_updated": "2020-07-11",
        "certification_date": "2020-07-11",
        "status": "A",
        "authorized_official_last_name": "NKOLOMI",
        "authorized_official_first_name": "VELILE",
        "authorized_official_middle_name": "SIBUSISIWE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-733-2090",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bronse International
• Jacqueline Renea Brooks
• Tracie Brooks, STA
• Caryn Kelcy Bross, M.S.CCCSLP

• Psychiatric/Mental Health Nurse Practitioner in Garland, TX
• Providers in Garland, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.