Ketamine Wellness Centers Arizona LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

KETAMINE WELLNESS CENTERS ARIZONA LLC

Practice address

113 W Hoover Ave Ste 101
Mesa, AZ 85210-5214

Phone

(855) 538-9355

Fax

(844) 538-9355

NPI assigned

Jun 26, 2015

Organization subpart

No

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

Authorized official

Name

Anita Jerger

Title

Executive Assistant

Phone

(855) 538-9355

Specialties & licenses 3

Addresses

Other names 1

• Ketamine Wellness Centers Doing business as

Electronic endpoints 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Ketamine Wellness Centers Phoenix LLC

  • Anesthesiology Physician
  • Phoenix, AZ
  • NPI 1205597788
  NPPES parent name

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

{
    "created_epoch": "1435276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1477935369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 W HOOVER AVE STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105214",
            "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": "113 W HOOVER AVE STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105214",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS CENTERS ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-26",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A",
        "authorized_official_last_name": "JERGER",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "855-538-9355"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Mesa",
            "affiliation": "N",
            "address_1": "113 W Hoover Ave Ste 101",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852105214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ketamine Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• M Michelle Kerwin, R.N.
• Denise Kesaris
• Diana Lynne Kesler-la Clair, RN FNP
• Stephen Kessler II, M.D.
• Ketamine America LLC
• Thomas J Ketterer, M.D.
• Kevin Warren
• Tonya Lorraine Keyes-Christianson, MA, RD
• Keegan Keyes
• Keystone Natural Family Medicine

• Anesthesiology Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Anesthesiology Physician in Arizona

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