NPIMap

Organization Active NPI

Ketamine and IV Therapy Clinic of Nwa LLC

  • Certified Registered Nurse Anesthetist
  • Lowell, AR
National Provider Identifier
1609654847
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
KETAMINE AND IV THERAPY CLINIC OF NWA LLC
Practice address
101 Grant PL Ste C
Lowell, AR 72745-7103
Phone
(479) 318-2382
Fax
(479) 318-2416
NPI assigned
Sep 19, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Chelsi Musick, CRNANPI 1053722132
Title
Owner
Phone
(479) 318-2382

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
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

101 Grant PL Ste C
Lowell, AR 72745-7103

Mailing address

101 Grant PL Ste C
Lowell, AR 72745-7103
Phone (479) 318-2382

Other practice location 1

1631 NE Douglas St
Lees Summit, MO 64086-4701
Phone (816) 381-2050

Other names 1

  • ascend wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240603003761 AR Part B Supplier - Clinic/Group Practice 6507308707 Receives reassigned benefits from 12 practitioners
Practice locations: Lowell, AR; Rogers, AR
O20250327003531 MO Part B Supplier - Clinic/Group Practice 6507308707 Receives reassigned benefits from 6 practitioners
Practice locations: Lees Summit, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1609654847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 GRANT PL STE C",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727457103",
            "telephone_number": "479-318-2382",
            "fax_number": "479-318-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 GRANT PL STE C",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727457103",
            "telephone_number": "479-318-2382",
            "fax_number": "479-318-2416"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1631 NE Douglas St",
            "address_purpose": "LOCATION",
            "city": "Lees Summit",
            "state": "MO",
            "postal_code": "640864701",
            "country_code": "US",
            "telephone_number": "816-381-2050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KETAMINE AND IV THERAPY CLINIC OF NWA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "MUSICK",
        "authorized_official_first_name": "CHELSI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-318-2382",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ascend wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lowell, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; 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.