Prosper Ketamine & IV Nutrition Therapy LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

PROSPER KETAMINE & IV NUTRITION THERAPY LLC

Practice address

1400 N Coit Rd Ste 1103
McKinney, TX 75071-6659

Phone

(469) 584-9905

Fax

(469) 343-1998

NPI assigned

Sep 8, 2023

Organization subpart

No

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

Authorized official

Name

Bercey Ntoung

Title

Administrator

Phone

(469) 584-9905

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

• Berenice Bisong

  • Certified Registered Nurse Anesthetist
  • Dallas, TX
  • NPI 1366818312
  Medicare reassignment NPD

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

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1174300693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N COIT RD STE 1103",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750716659",
            "telephone_number": "469-584-9905",
            "fax_number": "469-343-1998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N COIT RD STE 1103",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750716659",
            "telephone_number": "469-584-9905",
            "fax_number": "469-343-1998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPER KETAMINE & IV NUTRITION THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "NTOUNG",
        "authorized_official_first_name": "BERCEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "469-584-9905"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Progressive Health Diagnostics
• Progressive Health Family Medicine
• Progressive Health Surgery Center LLC
• Progressive Health Surgery Center LLC
• David Michael Proost, PHD
• Prosper Womens Health PLLC
• Valerie Prosser
• Prudent Family Dentistry of McKinney PLLC
• John Francis Prudich, M.D.
• Psychiatric Associates of McKinney

• Pain Medicine (Anesthesiology) Physician in McKinney, TX
• Providers in McKinney, TX by specialty
• Pain Medicine (Anesthesiology) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.