Provider Demographics
NPI:1053290536
Name:BROUGHTON, MOLLY NOELLE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:NOELLE
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 RIDGEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3386
Mailing Address - Country:US
Mailing Address - Phone:573-822-8885
Mailing Address - Fax:
Practice Address - Street 1:8025 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5360
Practice Address - Country:US
Practice Address - Phone:573-822-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program