Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jerriod Nicholas Broadnax, LADAC, NCAC-II, CFC

Individual provider Counselor · NPI 1427116581

Jerriod Nicholas Broadnax, LADAC, NCAC-II, CFC is a Mental Health Counselor in Fayetteville, Arkansas. Qualified in 2008, 18 years ago. Practices with Ketamine and IV Therapy Clinic of Nwa LLC, an 11-clinician group and accepts Medicare assignment. Licensed in Arkansas, Indiana and Virginia.

Years since qualifying
18
Licensed in
AR, IN, VA
In the registry since
2006
Specialties on file
4
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Practice location Address checks out

509 E Milsap Rd Ste 9
Fayetteville, AR 72703
Phone: (479) 879-7038
Fax: (479) 340-0500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 333L (AR)
Counselor Taxonomy 101Y00000X · Licence 28533 (IN)
Professional Counselor Taxonomy 101YP2500X · Licence 016701 (VA)
Case Manager/Care Coordinator Taxonomy 171M00000X

Record details

NPI number1427116581
Entity typeIndividual (Type 1)
GenderMale
Credentials LADAC , NCAC-II , CFC
Sole proprietorYes
NPI enumeratedDecember 4, 2006
Last updated in NPPESAugust 10, 2021
Certification dateAugust 10, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Ketamine And Iv Therapy Clinic Of Nwa Llc — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Fayetteville