Provider Demographics
NPI:1700548005
Name:COMPLETE KETAMINE SOLUTIONS
Entity type:Organization
Organization Name:COMPLETE KETAMINE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:615-300-3096
Mailing Address - Street 1:1916 PATTERSON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2126
Mailing Address - Country:US
Mailing Address - Phone:629-203-7113
Mailing Address - Fax:629-203-7138
Practice Address - Street 1:1916 PATTERSON ST STE 208
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2126
Practice Address - Country:US
Practice Address - Phone:629-203-7113
Practice Address - Fax:629-203-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty