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JENNIFER LAURA BROADT PA NPI 1962869776


NPI Information

NPI: 1962869776
Provider Name: JENNIFER LAURA BROADT, PA
Classification: Physician Assistant - 363A00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
915 WISCONSIN AVE
TIETON, WA
ZIP 98947
Phone: (509) 673-0044
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Jennifer Laura Broadt, PA is a physician assistant in Tieton, WA. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Jennifer Laura Broadt, PA NPI is 1962869776. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

915 WISCONSIN AVE
TIETON, WA
ZIP 98947-802
Phone: (509) 673-0044
Fax: (509) 673-0054

The NPI 1962869776 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/25/2016 and was last updated on 12/5/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician AssistantPA60703623WASHINGTONYes
2363A00000XPhysician AssistantTEXASNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
147272ZSJCOTHERTEXASMEDICARE
2P01610841OTHERTEXASRAILROAD MEDICARE
3354348002OTHERTEXASCSHCN MEDICAID
48860NUOTHERTEXASSOLO BCBS
5354348001MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.