MEDICARE: KETAMINE HOLISTIC WELLNESS CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse

General Provider Information

NPI Number	:	1114586138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KETAMINE HOLISTIC WELLNESS CENTER, PLLC

Provider Business Mailing Address
First Line	:	1024 HIGHWAY A1A STE 152
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-2341
Country	:	US
Telephone Number	:	321-777-8040
Fax Number	:	321-821-0212

Provider Business Practice Location Address
First Line	:	1024 HIGHWAY A1A STE 152
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-2341
Country	:	US
Telephone Number	:	321-777-8040
Fax Number	:	321-821-0212

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KYMBERLY TESH PIERCE-DEW
Credential	:
Telephone Number	:	941-720-5448

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/12/2019

Similar Medicare Providers

1962454249 — DR. JENIFER E ESPENSCHEID DC
Practice Location Address:

9042 GARFIELD AVE STE 103
HUNTINGTON BEACH, CA
92646-2341

Practice Phone: 714-223-1114
Practice Fax:

1881825669 — HANA IBRAHIMOVIC MCDERMOTT
Practice Location Address:

2000 VOORHEES AVE UNIT 7
REDONDO BEACH, CA
90278-2341

Practice Phone: 310-429-4309
Practice Fax:

1700187358 — MRS. TARA STEGALL HOMEIER LCSW
Practice Location Address:

2341 S MILITARY TRL
WEST PALM BEACH, FL
33415-7543

Practice Phone: 561-202-4277
Practice Fax:

1841859261 — TYLER BIGENHO DC
Practice Location Address:

4121 WESTERLY PL STE 115
NEWPORT BEACH, CA
92660-2341

Practice Phone: 714-227-1125
Practice Fax: 949-209-0349

1679167894 — HYDRATION EXPERIENCE
Practice Location Address:

1329 NW 10TH ST
DANIA BEACH, FL
33004-2341

Practice Phone: 954-765-9521
Practice Fax:

1952154056 — OCEANS HEALTHCARE
Practice Location Address:

1555 PALM BEACH LAKES BLVD STE 950
WEST PALM BEACH, FL
33401-2341

Practice Phone: 337-315-7927
Practice Fax:

Directions to “KETAMINE HOLISTIC WELLNESS CENTER, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.