865 Wellness Ketamine LLC
Organization Active NPI Certified Registered Nurse Anesthetist · Knoxville, TN
NPI 1912696808 · NPPES record last updated Jul 23, 2025
Key facts
- NPI
- 1912696808
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- Legal business name
- 865 WELLNESS KETAMINE LLC
- Practice address
- 601 S Concord St Ste 100
Knoxville, TN 37919-3339 - Phone
- (865) 805-3118
- Fax
- (865) 415-2841
- NPI assigned
- May 5, 2023
- Organization subpart
- No
Authorized official
- Name
- Jennifer Watson, CRNA
- Title
- Owner
- Phone
- (865) 223-2468
Practitioners 1
-
Jennifer Devault Watson, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250829000377 | TN | Part B Supplier - Clinic/Group Practice | 8527569748 |
Receives reassigned benefits from 1 practitioner Practice locations: Knoxville, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist |
367500000X | Yes |
Addresses
Primary practice location
601 S Concord St Ste 100
Knoxville, TN 37919-3339
Mailing address
601 S Concord St Ste 100
Knoxville, TN 37919-3339
Phone (865) 805-3118
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.