Ketamine West LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

KETAMINE WEST LLC

Practice address

602 26 1/2 Rd
Grand Junction, CO 81506-1905

Phone

(970) 427-4000

NPI assigned

Jul 16, 2022

Last updated

Dec 20, 2022By 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

Stryder River Reilly, APRNNPI 1861780199

Title

Owner/Operator

Phone

(970) 644-1279

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stryder River Reilly, RXN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Junction, CO
  • NPI 1861780199
  Medicare reassignment NPD Authorized official
• Chris K Polsley, PA

  • Physician Assistant
  • Montrose, CO
  • NPI 1124344080
  Medicare reassignment

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

{
    "created_epoch": "1657929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1477287290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 26 1/2 RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815061905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 26 1/2 RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815061905",
            "telephone_number": "970-427-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "836 S Townsend Ave",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "CO",
            "postal_code": "814014360",
            "country_code": "US",
            "telephone_number": "970-200-8365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KETAMINE WEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-16",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "STRYDER",
        "authorized_official_middle_name": "RIVER",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "970-644-1279",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@ketaminewest.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "602 26 1/2 Rd",
            "city": "Grand Junction",
            "state": "CO",
            "country_code": "US",
            "postal_code": "815061905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.ketaminewest.com",
            "affiliation": "N",
            "address_1": "602 26 1/2 Rd",
            "city": "Grand Junction",
            "state": "CO",
            "country_code": "US",
            "postal_code": "815061905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kenneth C. Lewis MD,LLC
• Kenneth C. Lewis MD,LLC
• Kelsey Lee Kerton, D.O.
• Bradley Robert Kessler
• Ketamine Infusion Specialists
• Julie A Ketchem, BA
• Sheryl Ketchum
• Kevin H. Howell DO
• Kevin K Howell
• Kelsi Keyek, FNP-BC, RN

• Mental Health Clinic/Center (Including Community Mental Health Center) in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.