Ketamine Ok LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

KETAMINE OK LLC

Practice address

1105 SW 30TH CT
Moore, OK 73160-2887

Phone

(405) 703-0937

Fax

(405) 378-2776

NPI assigned

Mar 6, 2019

Organization subpart

No

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

Authorized official

Name

Julie Dudley

Title

Practice Manager

Phone

(405) 703-0937

Specialties & licenses 1

Addresses

Other names 1

• Ketamine OK LLC Doing business as

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1649738865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SW 30TH CT",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602887",
            "telephone_number": "405-703-0937",
            "fax_number": "405-378-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SW 30TH CT",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602887",
            "telephone_number": "405-703-0937",
            "fax_number": "405-378-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE OK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "405-703-0937"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine OK LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ella Sue Kendrick
• Kenmore Eyecare Center
• Todd Alan Kenmore, O.D.
• Dave Sanford Kerby, PHD
• Landon Wade Kersey, ATC, LAT
• Cerissa Kalani Key, D.O.
• Joe Khong, LPC-C
• Derek Kielkopf
• Dallas Kilgore, M.A., BCBA
• Sunmin Kim, MD

• Psychiatry Physician in Moore, OK
• Providers in Moore, OK by specialty
• Psychiatry Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.