Ketamine America LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

KETAMINE AMERICA LLC

Practice address

4838 E Baseline Rd Ste 110
Mesa, AZ 85206-4674

Phone

(480) 426-0767

Fax

(480) 436-6611

NPI assigned

May 15, 2021

Organization subpart

No

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

Authorized official

Name

David A Warkentin, DC

Title

Ceo/Owner

Phone

(310) 770-6368

Specialties & licenses 6

Addresses

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

{
    "created_epoch": "1621036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621036800000",
    "number": "1053985986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4838 E BASELINE RD STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064674",
            "telephone_number": "480-426-0767",
            "fax_number": "480-436-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4838 E BASELINE RD STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064674",
            "telephone_number": "480-426-0767",
            "fax_number": "480-436-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE AMERICA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-15",
        "last_updated": "2021-05-15",
        "certification_date": "2021-05-15",
        "status": "A",
        "authorized_official_last_name": "WARKENTIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "310-770-6368",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerry S Green MD PLC
• M Michelle Kerwin, R.N.
• Denise Kesaris
• Diana Lynne Kesler-la Clair, RN FNP
• Stephen Kessler II, M.D.
• Ketamine Wellness Centers Arizona LLC
• Thomas J Ketterer, M.D.
• Kevin Warren
• Tonya Lorraine Keyes-Christianson, MA, RD
• Keegan Keyes

• Pain Medicine Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pain Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2021; 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.