1437151636 NPI number — MS. ROMONA BROUSSARD MAYEUX FNP-BC

Table of content: MS. ROMONA BROUSSARD MAYEUX FNP-BC (NPI 1437151636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437151636 NPI number — MS. ROMONA BROUSSARD MAYEUX FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYEUX
Provider First Name:
ROMONA
Provider Middle Name:
BROUSSARD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437151636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 E CAPITOL ST
Provider Second Line Business Mailing Address:
ROOM 105
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39201-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-714-2563
Provider Business Mailing Address Fax Number:
601-510-4653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 E CAPITOL ST
Provider Second Line Business Practice Location Address:
ROOM 105
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39201-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-714-2563
Provider Business Practice Location Address Fax Number:
601-510-4653
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN041380 AP01824 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R881289 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AP01824 . This is a "APN LICENSE NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1655244 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: R881289 . This is a "MISSISSIPPI STATES BOARD OF NURSING" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: RN041380 . This is a "RN LICENSE NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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