Individual ProviderIrene L BroussardNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3705 Medical Pkwy, Suite 570, Austin, TX 78705(512) 454-2454(972) 233-1999PECOS EnrollmentBased on the most recent information from CMS, provider Irene L Broussard does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1548242217Provider TypeIndividualFull NameBroussard, Irene LCredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date11/17/2005Last Updated6/1/2018Contact InformationPractice LocationPractice Address3705 Medical Pkwy, Suite 570, Austin, TX 78705Phone(512) 454-2454Fax(512) 454-1532Mailing LocationMailing AddressPO Box 840853, Dallas, TX 75284-0853Phone(972) 233-1999Fax(972) 233-3666Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense42127TexasProvider IdentifiersIDDescriptionIssuerID80268CDescriptionOtherIssuerBC/BSTexasID88567501DescriptionMedicaidIssuerUnlistedTexas