Affordable Ketamine Clinics, LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

AFFORDABLE KETAMINE CLINICS, LLC

Practice address

375 N Main St Ste 202
Kaysville, UT 84037-1278

Phone

(801) 450-7147

Fax

(385) 209-2975

NPI assigned

Jan 9, 2021

Organization subpart

No

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

Authorized official

Name

Royce B Bartholomew, CRNANPI 1851352165

Title

Owner/Manager

Phone

(801) 372-1888

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Royce Baird Bartholomew, CRNA

  • Certified Registered Nurse Anesthetist
  • Mountain Green, UT
  • NPI 1851352165

  Nurse Anesthetist, Certified Registered

  NPD Authorized official

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

{
    "created_epoch": "1610150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610150400000",
    "number": "1568050052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N MAIN ST STE 202",
            "city": "KAYSVILLE",
            "state": "UT",
            "postal_code": "840371278",
            "telephone_number": "801-450-7147",
            "fax_number": "385-209-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N MAIN ST STE 202",
            "city": "KAYSVILLE",
            "state": "UT",
            "postal_code": "840371278",
            "telephone_number": "801-450-7147",
            "fax_number": "385-209-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFORDABLE KETAMINE CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-09",
        "last_updated": "2021-01-09",
        "certification_date": "2021-01-09",
        "status": "A",
        "authorized_official_last_name": "BARTHOLOMEW",
        "authorized_official_first_name": "ROYCE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "801-372-1888",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528884092034",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Certified Registered Nurse Anesthetist in Kaysville, UT
• Providers in Kaysville, UT by specialty
• Certified Registered Nurse Anesthetist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.