Kketamine PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KKETAMINE PLLC

Practice address

98 Winchester St
Monroe, MI 48161-1957

Phone

(734) 605-8500

Fax

(734) 242-8563

NPI assigned

Dec 20, 2024

Organization subpart

No

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

Authorized official

Name

Codie Vassar, MD

Title

Owner

Phone

(734) 605-8500

Specialties & licenses 2

Addresses

Practitioners 1

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

• Christa Irene Klyder, CRNA

  • Certified Registered Nurse Anesthetist
  • Toledo, OH
  • NPI 1760706832
  NPD

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

{
    "created_epoch": "1734652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1831907914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 WINCHESTER ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481611957",
            "telephone_number": "734-605-8500",
            "fax_number": "734-242-8563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 WINCHESTER ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481611957",
            "telephone_number": "734-605-8500",
            "fax_number": "734-242-8563"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3104 S Cedar St",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489103481",
            "country_code": "US",
            "telephone_number": "734-605-8500",
            "fax_number": "734-242-8563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KKETAMINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-20",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "VASSAR",
        "authorized_official_first_name": "CODIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-605-8500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Jane Kipp, RPH
• Robert Kipplen, PHARMD
• Mary Alicia-Dana Kirk, NP
• Donald Jeffrey Kiss, D.D.S.
• James Kittson-Parriet
• Sarah Klawitter
• Alfred Gustav Klein, PT
• Alida Klein, OTRL
• Stephanie Kline
• Samantha Klipp, D.D.S.

• Clinic/Center in Monroe, MI
• Providers in Monroe, MI by specialty
• Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; 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.