Las Vegas Ketamine LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

LAS VEGAS KETAMINE LLC

Practice address

7390 W Sahara Ave Ste 270
Las Vegas, NV 89117-2765

Phone

(702) 957-0468

NPI assigned

Nov 17, 2022

Organization subpart

No

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

Authorized official

Name

Adam C Fisher

Title

Owner/Manager

Phone

(229) 412-5844

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 5

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

• Richard J Bennett, MD

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1699112185
  Medicare reassignment NPD
• Nipaporn Tina Buadaeng, APRN

  • Nurse Practitioner
  • Las Vegas, NV
  • NPI 1366939019

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Paul Quayle Reynolds, M.D.

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1437323169
  NPD
• Alec Chase Runyon

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1003236860
  NPD
• Jacob A Uhler, M.D.

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1396061057
  NPD (past)

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

{
    "created_epoch": "1668643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779408000000",
    "number": "1710696877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5519 BRUIN LAKES ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891315921",
            "telephone_number": "229-412-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7390 W SAHARA AVE STE 270",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891172765",
            "telephone_number": "702-957-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAS VEGAS KETAMINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-17",
        "last_updated": "2026-05-22",
        "certification_date": "2026-05-22",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "229-412-5844"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "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": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE WEST",
            "identifier": "1407158694",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lasvegasketamine@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3650 N Rancho Dr",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891303150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2026; 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.