Broussard, Jessirae

Broussard, Jessirae is an individual health care provider with primary practice located at 2525 Glenn Hendren Dr Anesthesia Dept, Liberty MO 64068-9625. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant, which is considered as her primary health care specialty. Broussard, Jessirae can be contacted via phone (816) 781-7200.

Contact Information

Primary practice address
2525 Glenn Hendren Dr Anesthesia Dept Liberty MO 64068-9625
Phone: (816) 781-7200
Fax: (816) 792-7196
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 2014018078 Missouri

Profile Details

NPI number 1326452962
LBN Legal business name Broussard, Jessirae
Credentials Associate of Arts (AA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 11th, 2014
Last updated Dec 9th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326452962 NPPES
Missouri Other P01350390 RAILROAD
Missouri Other 50498011 RAILROAD
Missouri MEDICAID 1326452962 RAILROAD

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