Ketamine Rva

Primary specialty

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

Legal business name

KETAMINE RVA

Practice address

8639 Mayland Dr Ste 102
Henrico, VA 23294-4752

Phone

(804) 993-3039

NPI assigned

Oct 25, 2024

Organization subpart

No

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

Authorized official

Name

Jon FrederickNPI 1003997800

Title

Owner

Phone

(804) 993-3039

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.

• Jon Randall Frederick, M.D.

  • Emergency Medicine Physician
  • Richmond, VA
  • NPI 1003997800
  NPD Authorized official

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

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1063234615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8639 MAYLAND DR STE 102",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232944752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8639 MAYLAND DR STE 102",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232944752",
            "telephone_number": "804-993-3039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE RVA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-993-3039"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kelly, LPC
• Kristen Kelly, RBT
• John Michael Christian Kenerson, M.D.
• Marita Kershaw
• Kesell Express LLC
• Erin Kathleen Ketterman
• Key Support Services, LLC
• Cheryl F Key, D.C.
• Khalid Karim MD Inc
• Hisham Taha Khudair

• Mental Health Clinic/Center (Including Community Mental Health Center) in Henrico, VA
• Providers in Henrico, VA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; 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.