Brenda A Broussard, RD, CDE, BC-ADM

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

License

036 Issued in NM

Practice address

Presbyterian Family Practice Medical Group
3901 Atrisco
Albuquerque, NM 87120

Phone

(505) 462-7575

NPI assigned

Apr 17, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962628156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 BERM ST NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201822",
            "telephone_number": "505-792-0065",
            "fax_number": "505-792-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PRESBYTERIAN FAMILY PRACTICE MEDICAL GROUP",
            "address_2": "3901 ATRISCO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87120",
            "telephone_number": "505-462-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "BRENDA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "RD, CDE, BC-ADM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "NM",
            "license": "036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phillip Mohler Brooks, M.D.
• Jonathan Brookshire
• Svetlana Brothers, NP
• Markham O Broughton
• Mary Louise Broughton
• Marque D Broussard, MD
• Leah Joy Brouwers, LMFT
• Julia Brovarney, CNP
• Julie Brovko, PH.D.
• Gabrielle Browder, BCABA

• Metabolic Nutrition Registered Dietitian in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Metabolic Nutrition Registered Dietitian in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.