Provider Demographics
NPI:1326763228
Name:BROUSSARD, ADRIENNE ELIZABETH (PA)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:ELIZABETH
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:604 N ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:877-795-9281
Practice Address - Street 1:604 N ACADIA RD STE 101
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4897
Practice Address - Country:US
Practice Address - Phone:985-446-5079
Practice Address - Fax:877-795-9281
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2024-03-13
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Provider Licenses
StateLicense IDTaxonomies
LA333706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant