Provider Demographics
NPI:1912751652
Name:BROADER POSSIBILITIES CLINICAL SERVICES PLLC
Entity Type:Organization
Organization Name:BROADER POSSIBILITIES CLINICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC, FNP-C
Authorized Official - Prefix:MS
Authorized Official - First Name:NATASHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADNAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-467-8686
Mailing Address - Street 1:952 GOLF HOUSE RD W STE I-655
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9286
Mailing Address - Country:US
Mailing Address - Phone:910-467-8686
Mailing Address - Fax:
Practice Address - Street 1:952 GOLF HOUSE RD W STE I-655
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9286
Practice Address - Country:US
Practice Address - Phone:910-467-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty