Ketamine Wellness Centers Tucson, LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

KETAMINE WELLNESS CENTERS TUCSON, LLC

Practice address

3130 N Swan Rd
Tucson, AZ 85712-1227

Phone

(855) 538-9355

Fax

(844) 538-9355

NPI assigned

Jun 7, 2019

Organization subpart

No

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

Authorized official

Name

Anita D Jerger

Title

Executive Assistant

Phone

(855) 538-9355

Specialties & licenses 3

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1154980753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3130 N SWAN RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857121227",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 N SWAN RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857121227",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS CENTERS TUCSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-07",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "JERGER",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "855-538-9355"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Tucson",
            "affiliation": "N",
            "address_1": "3130 N Swan Rd",
            "city": "Tucson",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "857121227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Monica Kesler, LCSW
• Joshua Eric Kessler, PHARMD
• Amanda Louise Kester, AU.D.
• Teresa Farrell Kestler, FNP
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• Marta F. Ketchel, PH.D.
• Steven Ketchel, M.D.
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• Amanda O'Hanlon Kett, M.S., CCC-SLP

• Anesthesiology Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Anesthesiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; 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.