IndividualActive
Kendra Broussard, NNP
NPI 1346616604 · Critical Care Neonatal Nurse Practitioner · Salt Lake City, UT
Provider details
- NPI number
- 1346616604
- Entity type
- Individual
- Primary specialty
- Critical Care Neonatal Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NNP
- Sex
- Female
- Sole proprietor
- No
- License
- RN198466 (GA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
50 N Medical Dr
Nicu
Salt Lake City, UT 84132-0001
Phone: (801) 581-2113
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 742616
Atlanta, GA 30374-2616
Registry dates
- Enumerated
- 2015-08-20
- Last updated
- 2022-08-04
- Certified
- 2021-11-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.