Ketamine Holistic Wellness Center, PLLC

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

Legal business name

KETAMINE HOLISTIC WELLNESS CENTER, PLLC

Practice address

1024 Highway A1A Ste 152
Satellite Beach, FL 32937-2341

Phone

(321) 777-8040

Fax

(321) 821-0212

NPI assigned

Jun 12, 2019

Organization subpart

No

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

Authorized official

Name

Kymberly Tesh Pierce-Dew

Title

Billing Manager

Phone

(941) 720-5448

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.

• Louise Urbanc Peters, PSY.D.

  • Clinical Psychologist
  • Cape Canaveral, FL
  • NPI 1386699213
  NPD

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1114586138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 HIGHWAY A1A STE 152",
            "city": "SATELLITE BEACH",
            "state": "FL",
            "postal_code": "329372341",
            "telephone_number": "321-777-8040",
            "fax_number": "321-821-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 HIGHWAY A1A STE 152",
            "city": "SATELLITE BEACH",
            "state": "FL",
            "postal_code": "329372341",
            "telephone_number": "321-777-8040",
            "fax_number": "321-821-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE HOLISTIC WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-12",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "PIERCE-DEW",
        "authorized_official_first_name": "KYMBERLY",
        "authorized_official_middle_name": "TESH",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "941-720-5448"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Ann Johnson, OTR/L
• Jill Johnson, OTR
• Kristin Jones, MSOT/OTR/L
• Chelsea Elizabeth Kazmier, LCSW
• Judith Anne Kelso, BCBA
• Millard Kimball Jr., DDS
• Medhat Labib
• Joseph Latorre, L.M.T.
• Kathleen Leaf, MSW
• Theresa Ann Lee, CAP

• Psychiatric/Mental Health Registered Nurse in Satellite Beach, FL
• Providers in Satellite Beach, FL by specialty
• Psychiatric/Mental Health Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; 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.