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General NPI Number Information
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NPI Number | 1609654847
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Entity Type | Organization
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Legal Business Name | KETAMINE AND IV THERAPY CLINIC OF NWA LLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 101 GRANT PL STE C
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City | LOWELL
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State | AR
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Zip | 72745-7103
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Country | US
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Telephone | 479-318-2382
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Fax | 479-318-2416
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Provider Business Mailing Address
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Address Line | 101 GRANT PL STE C
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City | LOWELL
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State | AR
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Zip | 72745-7103
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Country | US
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Telephone | 479-318-2382
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Fax | 479-318-2416
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Authorized Official
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Title or Position | OWNER
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Name | CHELSI MUSICK
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Credential | CRNA
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Telephone | 479-318-2382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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