Provider Demographics
NPI:1831567387
Name:BROUSSARD, CASSIE (FNP-BC, PMHNP-BC DNP)
Entity type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 MILLS HWY
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-7304
Mailing Address - Country:US
Mailing Address - Phone:318-405-1031
Mailing Address - Fax:337-324-9049
Practice Address - Street 1:100 BEAUVAIS AVE STE A2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-2469
Practice Address - Country:US
Practice Address - Phone:318-405-1026
Practice Address - Fax:862-298-0802
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2024-10-02
Deactivation Date:2022-06-01
Deactivation Code:
Reactivation Date:2022-07-01
Provider Licenses
StateLicense IDTaxonomies
TXAP128734363LF0000X
WAAP61202915363LP0808X
LAAP08875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty