Active NPI
Kimberly R Broussard
- Behavior Analyst
- Las Vegas, NV
National Provider Identifier
1801166848
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jul 20, 2022.
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 263 Spring Hollow Dr
Las Vegas, NV 89148-2502 - Phone
- (702) 807-1718
- NPI assigned
- Jan 6, 2012
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
263 Spring Hollow Dr
Las Vegas, NV 89148-2502
Mailing address
PO Box 33838
Las Vegas, NV 89133-3838
Phone (702) 807-1718
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1801166848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 33838",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891333838",
"telephone_number": "702-807-1718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "263 SPRING HOLLOW DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891482502",
"telephone_number": "702-807-1718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "KIMBERLY",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-06",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.