Provider Demographics
NPI:1184421877
Name:BROUSSARD, KIMBERLY EPPERLY (RDN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EPPERLY
Last Name:BROUSSARD
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RAEANN
Other - Last Name:EPPERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:12269 LA HWY 699
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-3604
Mailing Address - Country:US
Mailing Address - Phone:337-658-9188
Mailing Address - Fax:337-658-9188
Practice Address - Street 1:12269 LA HWY 699
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-3604
Practice Address - Country:US
Practice Address - Phone:337-658-9188
Practice Address - Fax:337-658-9188
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1022530133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered