Provider Demographics
NPI:1609654847
Name:KETAMINE AND IV THERAPY CLINIC OF NWA LLC
Entity type:Organization
Organization Name:KETAMINE AND IV THERAPY CLINIC OF NWA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:479-318-2382
Mailing Address - Street 1:101 GRANT PL STE C
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-7103
Mailing Address - Country:US
Mailing Address - Phone:479-318-2382
Mailing Address - Fax:479-318-2416
Practice Address - Street 1:101 GRANT PL STE C
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-7103
Practice Address - Country:US
Practice Address - Phone:479-318-2382
Practice Address - Fax:479-318-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty