Texas Ketamine Specialists

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

TEXAS KETAMINE SPECIALISTS

Practice address

12740 Hillcrest Rd Ste 295
Dallas, TX 75230-7108

Phone

(469) 774-3069

NPI assigned

Nov 8, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Andrea Kim, MD

Title

Physician

Phone

(469) 774-3069

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Brooke Marron Caldwell, MSN, RN, AGNP-C

  • Adult Health Nurse Practitioner
  • Dallas, TX
  • NPI 1043785744
  NPD (past)

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

{
    "created_epoch": "1573171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573171200000",
    "number": "1225673643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12740 HILLCREST RD STE 295",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752307108",
            "telephone_number": "469-774-3069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12740 HILLCREST RD STE 295",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752307108",
            "telephone_number": "469-774-3069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6446 Colleyville Blvd.",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Colleyville",
            "state": "TX",
            "postal_code": "76034",
            "country_code": "US",
            "telephone_number": "469-844-1350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEXAS KETAMINE SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-08",
        "last_updated": "2019-11-08",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "469-774-3069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Texas Lung Center, P.a.
• Texas Malone Healthcare, LLC (Ijworks)

• Psychiatry Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.