Broken Arrow Pain Specialist, LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

BROKEN ARROW PAIN SPECIALIST, LLC

Practice address

2028 Mahaney Ave
Tahlequah, OK 74464-5783

Phone

(918) 992-6050

Fax

(833) 763-2349

NPI assigned

Sep 21, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ian Kelley

Title

Sole Member

Phone

(918) 633-0447

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Oklahoma Pain Specialist Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Tax ID family

Broken Arrow Pain Specialist2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Broken Arrow Pain Specialist, LLC

  • Pain Medicine Physician
  • Tahlequah, OK
  • NPI 1528749355
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Gail Reneau, APRN-CNP

  • Family Nurse Practitioner
  • Broken Arrow, OK
  • NPI 1639942105
  Medicare reassignment Care Compare group NPD
• Michelle Shannon Wells, D.O.

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1699989509
  Medicare reassignment Care Compare group NPD
• Cara Guariglia, M.D.

  • General Practice Physician
  • Tulsa, OK
  • NPI 1467779710
  Medicare reassignment NPD
• Chad Eric Keeney, DO

  • Family Medicine Physician
  • Joplin, MO
  • NPI 1134149180

  OK

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784678400000",
    "number": "1104549427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 MAHANEY AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645783",
            "telephone_number": "918-992-6050",
            "fax_number": "833-763-2349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 MAHANEY AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645783",
            "telephone_number": "918-992-6050",
            "fax_number": "833-763-2349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROKEN ARROW PAIN SPECIALIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "918-633-0447"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200121490A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oklahoma Pain Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Norma Brightly
• Summer Lynn Brixey, COTA/L
• Thomas Ray Brixey, JD, MS
• Kristi Broadhead
• Kayce Brock
• Broken Arrow Pain Specialist, LLC
• Austin Tanner Brookover, DO
• Debbie Marie Brooks
• Brookshire Grocery Company
• Amy Brown

• Pain Medicine Physician in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Pain Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.