JERRIOD NICHOLAS BROADNAX LADAC NCAC-II CFC NPI 1427116581

NPI Information

  • NPI: 1427116581
  • Provider Name: JERRIOD NICHOLAS BROADNAX, LADAC, NCAC-II, CFC
  • Classification: Counselor - 101YA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Individual
  • Address: 509 E. MILSAP ROAD
    SUITE 9
    FAYETTEVILLE, AR
    ZIP 72703
  • Phone: (479) 879-7038

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NPI Details

Jerriod Nicholas Broadnax, LADAC, NCAC-II, CFC is an addiction (substance use disorder) counselor in Fayetteville, AR. Jerriod Nicholas Broadnax, LADAC, NCAC-II, CFC NPI is 1427116581. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

509 E. MILSAP ROAD
SUITE 9
FAYETTEVILLE, AR
ZIP 72703
Phone: (479) 879-7038
Fax: (479) 340-0500

The enumeration date for this NPI number is 12/4/2006 and was last updated on 8/10/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101Y00000XCounselor28533INDIANANo
2101YA0400XCounselorAddiction (Substance Use Disorder)333LARKANSASYes
3101YP2500XCounselorProfessional016701VIRGINIANo
4171M00000XCase Manager/Care CoordinatorNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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