Provider Demographics
NPI:1134668411
Name:BROUSSARD, CRYSTAL (FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:4401 S CLAIBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-5105
Mailing Address - Country:US
Mailing Address - Phone:504-891-7737
Mailing Address - Fax:
Practice Address - Street 1:203 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3815
Practice Address - Country:US
Practice Address - Phone:337-266-8483
Practice Address - Fax:337-266-8463
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily