Provider Demographics
NPI:1174879282
Name:BRODERICK, KIERON JAMES (RN, ACNP)
Entity type:Individual
Prefix:MR
First Name:KIERON
Middle Name:JAMES
Last Name:BRODERICK
Suffix:
Gender:M
Credentials:RN, ACNP
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Mailing Address - Street 1:3901 SPICEWOOD SPRINGS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8723
Mailing Address - Country:US
Mailing Address - Phone:877-279-5960
Mailing Address - Fax:877-384-3106
Practice Address - Street 1:1208 E CROSS ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-3501
Practice Address - Country:US
Practice Address - Phone:816-477-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2022-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2012024476363LA2100X
IAL166512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care