Ketamine West LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

KETAMINE WEST LLC

Practice address

836 S Townsend Ave Ste a
Montrose, CO 81401-4360

Phone

(970) 200-8365

NPI assigned

Dec 27, 2022

Last updated

Sep 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stryder River ReillyNPI 1861780199

Title

Nurse Practitioner

Phone

(970) 644-1279

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stryder River Reilly, RXN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Junction, CO
  • NPI 1861780199
  NPD Authorized official

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

{
    "created_epoch": "1672099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1003529728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 26 1/2 RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815061905",
            "telephone_number": "970-644-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 S TOWNSEND AVE STE A",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814014360",
            "telephone_number": "970-200-8365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-27",
        "last_updated": "2023-09-06",
        "certification_date": "2022-12-27",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "STRYDER",
        "authorized_official_middle_name": "RIVER",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "970-644-1279"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Keil, PT DPT
• Jean Richele Kelley, RN
• Jack Kelly
• Kellyn Kennedy, PHARM.D.
• Kensho Total Wellness Day Spa, LLC
• Keystone Behavioral Consultation LLC
• Keystone Physical Therapy LLC
• Patricia Kiebler, CRNA
• Robert G Kilbourn, M.D., PHD
• Kenneth W Kincaide, MA

• Mental Health Clinic/Center (Including Community Mental Health Center) in Montrose, CO
• Providers in Montrose, CO by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.