Active Ketamine, PLLC

Primary specialty

Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X

Legal business name

ACTIVE KETAMINE, PLLC

Practice address

12250 Queenston Blvd Ste E
Houston, TX 77095-5343

Phone

(281) 201-4511

NPI assigned

May 11, 2022

Organization subpart

No

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

Authorized official

Name

Jared HeathmanNPI 1972820215

Title

Managing Member

Phone

(281) 201-4511

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

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

• Jared Heathman, MD

  • Psychiatry Physician
  • Cypress, TX
  • NPI 1972820215
  NPD Authorized official

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

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1073259156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12250 QUEENSTON BLVD STE E",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770955343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12250 QUEENSTON BLVD STE E",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770955343",
            "telephone_number": "281-201-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE KETAMINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "HEATHMAN",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "281-201-4511"
    },
    "taxonomies": [
        {
            "code": "2084P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.ActiveKetamine.com",
            "affiliation": "N",
            "address_1": "12250 Queenston Blvd Ste E",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770955343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pain Medicine (Psychiatry & Neurology) Physician in Houston, TX
• Providers in Houston, TX by specialty
• Pain Medicine (Psychiatry & Neurology) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; 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.