Ketamine123Llc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

KETAMINE123LLC

Doing business as

Ketamine Solutions of Tampa

Practice address

3450 E Fletcher Ave Ste 300
Tampa, FL 33613-4659

Phone

(813) 632-3223

Fax

(813) 632-3224

NPI assigned

Oct 20, 2021

Last updated

Nov 10, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Clint Fletcher, CRNA

Title

Owner

Phone

(615) 300-3096

Specialties & licenses 1

Addresses

Other names 1

• Ketamine Solutions of Tampa Doing business as

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1265195812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 E FLETCHER AVE STE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336134659",
            "telephone_number": "813-632-3223",
            "fax_number": "813-632-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 E FLETCHER AVE STE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336134659",
            "telephone_number": "813-632-3223",
            "fax_number": "813-632-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE123LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-300-3096",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Solutions of Tampa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ketamine Solutions of Tampa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Marie Keslar, DO
• Stefan H. Kesler, CRNA
• Kari Danielle Kesner
• Jill E Kester, PT
• Kristi Kestner, RNC
• Natasha Ketchman, M.S., CCC-SLP
• Erica C. Keto, DPT
• Hind Kettani, M.D.
• Nicole Kettermann
• Dawn T Kettner, PA

• Multi-Specialty Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.