Provider Demographics
NPI:1952287963
Name:BROUSSARD, OLIVIA KATHRYN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KATHRYN
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-4008
Mailing Address - Country:US
Mailing Address - Phone:337-692-2860
Mailing Address - Fax:800-370-1055
Practice Address - Street 1:109 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-4008
Practice Address - Country:US
Practice Address - Phone:337-692-2860
Practice Address - Fax:800-370-1055
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health