NPIMap

Organization Active NPI

Avalyn Wellness and Ketamine LLC

  • Multi-Specialty Clinic/Center
  • Southlake, TX
National Provider Identifier
1356036933
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
AVALYN WELLNESS AND KETAMINE LLC
Practice address
1100 N Kimball Ave Ste 110
Southlake, TX 76092-4726
Phone
(817) 251-7995
Fax
(817) 398-0016
NPI assigned
Apr 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Steven Michael Appelhof, CRNANPI 1295324580
Title
Owner
Phone
(951) 956-8966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

1100 N Kimball Ave Ste 110
Southlake, TX 76092-4726

Mailing address

1100 N Kimball Ave Ste 110
Southlake, TX 76092-4726
Phone (951) 956-8966

National Provider Directory

National Provider Directory

Locations

1100 N Kimball Ave
Ste 110
Southlake, TX 76092
Phone (817) 251-7995

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1356036933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N KIMBALL AVE STE 110",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924726",
            "telephone_number": "951-956-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N KIMBALL AVE STE 110",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924726",
            "telephone_number": "817-251-7995",
            "fax_number": "817-398-0016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALYN WELLNESS AND KETAMINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "APPELHOF",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-956-8966",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.