Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Broken Arrow

Organization Addiction Medicine (Family Medicine) Physician · NPI 1720841042

Broken Arrow is an Addiction Medicine (Family Medicine) Physician in Jefferson City, Tennessee. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

1009 E Highway 11 E
Jefferson City, TN 37760-4910
Phone: (865) 935-0411
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction Medicine (Family Medicine) Physician (primary) Taxonomy 207QA0401X

Record details

NPI number1720841042
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Crissy Shank — Manager · (931) 761-5732
Other names Broken Arrow Llc
NPI enumeratedJanuary 31, 2024
Last updated in NPPESJanuary 31, 2024
Certification dateJanuary 31, 2024
Mailing address1009 E Highway 11 E, Jefferson City, TN 37760-4910