Active NPI
Wilfred Broussard, P.AP
- Physician Assistant
- Franklin, LA
National Provider Identifier
1922040153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- A10127
- Practice address
- 1115 Weber St
Franklin, LA 70538-4124 - Phone
- (337) 828-2550
- Fax
- (337) 355-2335
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | A10127 | LA | Primary |
Addresses
Primary practice location
1115 Weber St
Franklin, LA 70538-4124
Mailing address
1115 Weber St
Franklin, LA 70538-4124
Phone (337) 828-2550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1624888 | Medicaid | LA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A10127 | LA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550793600000",
"number": "1922040153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 WEBER ST",
"city": "FRANKLIN",
"state": "LA",
"postal_code": "705384124",
"telephone_number": "337-828-2550",
"fax_number": "337-828-5411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 WEBER ST",
"city": "FRANKLIN",
"state": "LA",
"postal_code": "705384124",
"telephone_number": "337-828-2550",
"fax_number": "337-355-2335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "WILFRED",
"credential": "P.AP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2019-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "LA",
"license": "A10127",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1624888",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Franklin, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.