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Organization
QUAD CITIES KETAMINE CLINIC
Active
Organization
QUAD CITIES KETAMINE CLINIC
Active
Other names
Quad Cities Ketamine & Wellness Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TARA M KINNEY CRNA (OWNER)
(563) 214-1594
Entity
Organization
Contact information
Practice address
4626 PROGRESS DR STE A, DAVENPORT, IA 52807-3485
(563) 214-1594
(563) 293-2803
Mailing address
4622 PROGRESS DR STE A, DAVENPORT, IA 52807-3426
(563) 214-1594
(563) 293-2803
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/02/2023
Last updated
06/18/2026
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