Ketamine Wellness Centers DFW, LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

KETAMINE WELLNESS CENTERS DFW, LLC

Practice address

6144 Precinct Line Rd Ste 100
Hurst, TX 76054-2610

Phone

(855) 538-9355

Fax

(844) 538-9355

NPI assigned

Jul 22, 2019

Last updated

Aug 21, 2020By the provider in NPPES

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

Electronic endpoints 1

Locations

Practitioners 1

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.

• Michelle Cheri Craft, FNP-C

  • Family Nurse Practitioner
  • Texarkana, TX
  • NPI 1013571876
  NPD (past)

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1770136475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6144 PRECINCT LINE RD STE 100",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760542613",
            "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": "6144 PRECINCT LINE RD STE 100",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760542610",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS CENTERS DFW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-22",
        "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": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Hurst",
            "affiliation": "N",
            "address_1": "6144 Precinct Line Rd Ste 100",
            "city": "Hurst",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760542610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Kasbaum, M.S., CCC-SLP
• Rhonda K Kay, PTA
• Sara Elise Kaylor, LPC, LCDC
• Stacy Keck, LPC
• Stephanie Vallari Kentner, CPM,LM
• Kevin G. Bui, DDS (Trinity Dental)
• Rajat Khadka, PA-C
• Khan Consulting LLC
• Arif Ahmad Khan, M.D.
• Jane Kim, OD

• Anesthesiology Physician in Hurst, TX
• Providers in Hurst, TX by specialty
• Anesthesiology Physician in Texas

• 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.