Healthcare Provider Details

I. General information

NPI: 1043148778
Provider Name (Legal Business Name): KALEA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2298 W HORIZON RIDGE PKWY STE 201
HENDERSON NV
89052-2698
US

IV. Provider business mailing address

2298 W HORIZON RIDGE PKWY STE 201
HENDERSON NV
89052-2698
US

V. Phone/Fax

Practice location:
  • Phone: 702-499-9393
  • Fax: 702-242-5252
Mailing address:
  • Phone: 702-499-9393
  • Fax: 702-242-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JANA GITNACHT
Title or Position: CLINIC MANAGER
Credential:
Phone: 210-315-8546