Ketamine Wellness Centers Washington

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

KETAMINE WELLNESS CENTERS WASHINGTON

Practice address

34709 9TH Ave S Ste B200
Federal Way, WA 98003-8724

Phone

(855) 538-9355

Fax

(844) 538-9355

NPI assigned

May 21, 2019

Organization subpart

Yes

Parent organization

KETAMINE WELLNESS CENTERS ARIZONA LLCAs reported in NPPES

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

Authorized official

Name

Anita D Jerger

Title

Executive Assistant

Phone

(855) 538-9355

Specialties & licenses 3

Addresses

Part of

Ketamine Wellness Centers Arizona LLC

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

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1457918831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34709 9TH AVE S STE B200",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038724",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34709 9TH AVE S STE B200",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038724",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS CENTERS WASHINGTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KETAMINE WELLNESS CENTERS ARIZONA LLC",
        "enumeration_date": "2019-05-21",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "JERGER",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "855-538-9355"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy E Kenzell, MS, OTR/L
• Tynia Amon Kercheval, PTA
• Karine Ann Kerns
• Tara Kerr
• Malavika Kesavan, MD
• Laura Lynn Kettel, DPT
• Key Compounding Pharmacy, LLC
• Key Health, Inc (Twin Lakes Chiropractic Clinic)
• Annie Li Keyes, CCC-SLP
• Christine Leah Keys, MA

• Anesthesiology Physician in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Anesthesiology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.