Northwest Ketamine Clinics Tacoma, PLLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

NORTHWEST KETAMINE CLINICS TACOMA, PLLC

Practice address

1901 S Union Ave
Building B, Suite 4001
Tacoma, WA 98405

Phone

(206) 309-2299

Fax

(425) 256-3250

NPI assigned

Jan 27, 2021

Organization subpart

No

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

Authorized official

Name

Allyn D Wilcock, ARNP

Title

Owner

Phone

(206) 330-6722

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1215528732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35302 SE CENTER ST",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980659216",
            "telephone_number": "206-330-6722",
            "fax_number": "425-256-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S UNION AVE",
            "address_2": "BUILDING B, SUITE 4001",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98405",
            "telephone_number": "206-309-2299",
            "fax_number": "425-256-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST KETAMINE CLINICS TACOMA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "WILCOCK",
        "authorized_official_first_name": "ALLYN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-330-6722",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.