Provider Demographics
NPI:1043409477
Name:TREVINO, CATHERINE BROUSSARD (FNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BROUSSARD
Last Name:TREVINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:BROUSSARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3420 VETERANS CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2552
Mailing Address - Country:US
Mailing Address - Phone:409-981-8550
Mailing Address - Fax:409-981-8593
Practice Address - Street 1:3420 VETERANS CIR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2552
Practice Address - Country:US
Practice Address - Phone:409-981-8550
Practice Address - Fax:409-981-8593
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760010407OtherEIN
TXCI5830Medicare PIN
TX8K0839Medicare PIN