Jason M Broussard (NPI# 1376744771, PAC ID# 2769508902) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PSYCHIATRY.
| Nation Provider ID (NPI) | 1376744771 |
| PAC ID by PECOS | 2769508902 |
| Professional Enrollment ID | I20100925000012 |
| Full Name | Jason M Broussard |
| Organization Legal Name | WK CENTER FOR PSYCHIATRIC SUPPORT |
| Address |
1111 Line Ave Shreveport LA 71101-3841 |
| Phone Number | 3187164610 |
| Gender | M |
| Graduation Year | 2006 |
| Primary Specialty | PSYCHIATRY |
| Group Practice PAC ID | 6406972645 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 190111 | WILLIS KNIGHTON MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1111 Line Ave, Shreveport, LA 71101-3841 | 3187164610 | WK CENTER FOR PSYCHIATRIC SUPPORT |
| Organization Legal Name | WK CENTER FOR PSYCHIATRIC SUPPORT |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shawn E. Mcneil | Psychiatry | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Kirsti N Peavy | Physician Assistant | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Arien M Ward | Psychologist, Clinical | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Devanshi Jani | Psychiatry | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Jeffrey T Overdyke | Psychiatry | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Street Address |
1111 LINE AVE |
| City | SHREVEPORT |
| State | LA |
| Zip | 71101-3841 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shawn E. Mcneil | Psychiatry | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Kirsti N Peavy | Physician Assistant | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Arien M Ward | Psychologist, Clinical | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Devanshi Jani | Psychiatry | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Albert M Aura | Internal Medicine | 1111 Line Ave, Shreveport, LA 71101-3841 | |
| Jeffrey T Overdyke | Psychiatry | Wk Center for Psychiatric Support | 1111 Line Ave, Shreveport, LA 71101-3841 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Caleb Blair Harkins | Nurse Practitioner | Wk North Pulmonary and Critical Care | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Mark H Smith | General Surgery | Wk South Surgical Hospitalists | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Matthew C Raley | Internal Medicine | Wk North Pulmonary and Critical Care | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Christina R Reynolds | Neurology | Wk Neurology Consultants | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Robert Todd Rickman | Critical Care (intensivists) | Wk North Pulmonary and Critical Care | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Venkat Raghav Aachi | Neurology | Wk Neurology Consultants | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Calvin D Alexander | Critical Care (intensivists) | Wk North Pulmonary and Critical Care | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Ernest A Little | Neurology | Wk Neurology Consultants | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Jonathan Eaton | Critical Care (intensivists) | Wk North Pulmonary and Critical Care | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Robert Taylor | Pulmonary Disease | Wk North Pulmonary and Critical Care | 1202 Louisiana Ave, Shreveport, LA 71101-3910 |
| Find all physicians in zip 71101 | |||
| City | SHREVEPORT |
| Zip Code | 71101 |
| Specialty | PSYCHIATRY |
| City + Specialty | SHREVEPORT + PSYCHIATRY |
Please comment or provide details below to improve the information on Jason M Broussard.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.