# KETAMINE WELLNESS CENTERS JACKSONVILLE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KETAMINE WELLNESS CENTERS ARIZONA LLC
- **Other names:** Ketamine Wellness Centers
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063016988
- **Legal business name:** KETAMINE WELLNESS CENTERS ARIZONA LLC
- **Authorized official:** MS. ANITA JERGER (EXECUTIVE ASSISTANT)
- **Authorized official phone:** (855) 538-9355

## Contact information

- **Practice address:** 3753-2 CARDINAL POINT DR, JACKSONVILLE, FL 32257-5582
- **Practice address phone:** (855) 538-9355
- **Practice address fax:** (844) 538-9355
- **Mailing address:** 113 W HOOVER AVE STE 101, MESA, AZ 85210-5214
- **Mailing address phone:** (855) 538-9355
- **Mailing address fax:** (844) 538-9355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/23/2020
- **Last updated:** 11/23/2020