Provider Demographics
NPI:1295025229
Name:BROUSSARD, KAREN CHEN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CHEN
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:740 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6448
Mailing Address - Country:US
Mailing Address - Phone:615-771-1881
Mailing Address - Fax:
Practice Address - Street 1:740 COOL SPRINGS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6448
Practice Address - Country:US
Practice Address - Phone:615-771-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN52214207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN52214OtherLICENSE