1184421877 NPI number — KIMBERLY EPPERLY BROUSSARD RDN

Table of content: KIMBERLY EPPERLY BROUSSARD RDN (NPI 1184421877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184421877 NPI number — KIMBERLY EPPERLY BROUSSARD RDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROUSSARD
Provider First Name:
KIMBERLY
Provider Middle Name:
EPPERLY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EPPERLY
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
RAEANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184421877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12269 LA HWY 699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAURICE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70555-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-658-9188
Provider Business Mailing Address Fax Number:
337-658-9188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12269 LA HWY 699
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAURICE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70555-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-658-9188
Provider Business Practice Location Address Fax Number:
337-658-9188
Provider Enumeration Date:
02/28/2025

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: 133V00000X , with the licence number:  1022530 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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