=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043148778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KALEA WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2026
-----------------------------------------------------
Last Update Date | 05/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2298 W HORIZON RIDGE PKWY STE 201
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-499-9393
-----------------------------------------------------
Fax | 702-242-5252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2298 W HORIZON RIDGE PKWY STE 201
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-499-9393
-----------------------------------------------------
Fax | 702-242-5252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC MANAGER
-----------------------------------------------------
Name | MS. JANA GITNACHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-315-8546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------