NPIMap

Organization Active NPI

Quad Cities Ketamine Clinic

Doing business as Quad Cities Ketamine & Wellness Clinic

  • Nurse Practitioner
  • Davenport, IA
National Provider Identifier
1629781935
Registry record updated Oct 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
QUAD CITIES KETAMINE CLINIC
Doing business as
Quad Cities Ketamine & Wellness Clinic
Practice address
4622 Progress Dr Ste a
Davenport, IA 52807-3426
Phone
(563) 214-1594
Fax
(563) 293-2803
NPI assigned
Jan 2, 2023
Last updated
Oct 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2026

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

Authorized official

Name
Tara M Kinney, CRNANPI 1164748646
Title
Owner
Phone
(563) 214-1594

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X

Addresses

Primary practice location

4622 Progress Dr Ste a
Davenport, IA 52807-3426

Mailing address

4622 Progress Dr Ste a
Davenport, IA 52807-3426
Phone (563) 214-1594

Other names 1

  • Quad Cities Ketamine & Wellness Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address contact@quadcitiesketamine.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1672617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791849600000",
    "number": "1629781935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4622 PROGRESS DR STE A",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073426",
            "telephone_number": "563-214-1594",
            "fax_number": "563-293-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4622 PROGRESS DR STE A",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073426",
            "telephone_number": "563-214-1594",
            "fax_number": "563-293-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAD CITIES KETAMINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-02",
        "last_updated": "2026-10-13",
        "certification_date": "2026-10-13",
        "status": "A",
        "authorized_official_last_name": "KINNEY",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-214-1594",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contact@quadcitiesketamine.com",
            "affiliation": "N",
            "endpointDescription": "Contact Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4626 Progress Dr Ste A",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528073485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Quad Cities Ketamine & Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2026; 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.