Ketamine Wellness Centers Minnesota, LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

KETAMINE WELLNESS CENTERS MINNESOTA, LLC

Practice address

11995 County Road 11 Ste 220
Burnsville, MN 55337-5102

Phone

(855) 538-9355

Fax

(844) 538-9355

NPI assigned

Jun 19, 2019

Organization subpart

No

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

Authorized official

Name

Anita D Jerger

Title

Executive Assistant

Phone

(855) 538-9355

Specialties & licenses 3

Addresses

Locations

Practitioners 1

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

• Kevin Nicholson

  • Registered Nurse
  • Mesa, AZ
  • NPI 1538725353
  NPD (past)

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1689234882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11995 COUNTY ROAD 11 STE 220",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375102",
            "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": "11995 COUNTY ROAD 11 STE 220",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375102",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS CENTERS MINNESOTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-19",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A",
        "authorized_official_last_name": "JERGER",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "855-538-9355"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Allan Kemnitz, DDS, MSD
• Sarah Lynn Kennedy
• Elisa Marie Kensinger, DC
• Kyla Miya-Jin Kessler, PT, DPT
• Terese Kessler
• Makayla Ketterling
• Ahmed Abdinasir Kewden
• Brigitta Hope Aadland Keyler
• Khalid A Khalid
• Aniso Khalif

• Anesthesiology Physician in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Anesthesiology Physician in Minnesota

• 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.