Kimberly Broussard
NPI 1477908275ActiveOrganization· Preferred Provider Organization· Las Vegas, NV
Listed on the HHS-OIG exclusion list since August 2022 (1128a1). Preferred Provider Organization in Las Vegas, Nevada, registered in NPPES in April 2016. The authorized official on file is Kimberly Rashone Broussard, Owner / Operator.
Overview
| NPI | 1477908275 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 28, 2016 |
| Last updated in NPPES | Apr 29, 2016 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Preferred Provider Organization Primary | 305R00000X | — | — |
| Behavior Analyst | 103K00000X | — | — |
Exclusion screening
This NPI appears on the OIG exclusion list. Excluded parties cannot be paid by Medicare, Medicaid or other federal health care programs, directly or through an employer.
| Matched by | Name on OIG list | Exclusion type | Excluded since | Location |
|---|---|---|---|---|
| NPI | Phenomenal Angels, LLC · Mental/Behavioral He | 1128a1 | Aug 18, 2022 | Las Vegas, NV |
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | Listed (NPI) | See above |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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