PHENOMENAL ANGELS
NPI 1477908275
Preferred Provider Organization in Las Vegas, NV

Q: What is Kimberly Broussard's NPI number?

The NPI number for Kimberly Broussard is 1477908275. It was assigned to this organization in the NPPES registry on April 28, 2016. The provider is doing business as Phenomenal Angels.

Q: What is Kimberly Broussard's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

Active since April 28, 2016

3380 E RUSSELL RD, SUITE 104, LAS VEGAS, NV 89120(702) 476-0448(702) 476-0449 Get Directions Write a Review

NPPES record last updated: April 29, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Phenomenal Angels NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHENOMENAL ANGELS (NPI 1477908275) is a healthcare organization registered as a preferred provider organization in Las Vegas, Nevada and active in the NPI registry since April 2016. The organization lists Kimberly Rashone Broussard, Owner / Operator, as its authorized official.

NPPES Registry Identity

NPI1477908275

Entity TypeOrganization

Primary Taxonomy305R00000X

Legal Business NameKIMBERLY BROUSSARD

Location Address3380 E RUSSELL RD, SUITE 104Las Vegas, NV 89120-3402

Mailing Address3380 E Russell Rd, Suite 104Las Vegas, NV 89120-3402 · (702) 476-0448 · Fax (702) 476-0449

Phone(702) 476-0448

Fax(702) 476-0449

Organization SubpartNo

Authorized OfficialKimberly Rashone BroussardOwner / Operator · (702) 807-1718

Enumeration DateApril 28, 2016

Last NPPES UpdateApril 29, 2016

✔ NPI 1477908275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations

Taxonomy Code305R00000X

Definition

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.

Also ListedBehavior AnalystTaxonomy 103K00000X

3380 E RUSSELL RD, Las Vegas, NV 89120

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Other Names 1

Doing Business AsPhenomenal Angels

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Broussard's NPI number?

The NPI number for Kimberly Broussard is 1477908275. It was assigned to this organization in the NPPES registry on April 28, 2016. The provider is doing business as Phenomenal Angels.

Where is Kimberly Broussard located?

Kimberly Broussard is located at 3380 E Russell Rd Suite 104, Las Vegas, NV 89120. The listed phone number is (702) 476-0448.

What is Kimberly Broussard's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

When was this NPI record last updated?

The NPPES record for Kimberly Broussard was last updated on April 29, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.