Organization
AVALYN WELLNESS AND KETAMINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN MICHAEL APPELHOF CRNA (OWNER)
(951) 956-8966
Entity
Organization
Contact information
Practice address
1100 N KIMBALL AVE STE 110, SOUTHLAKE, TX 76092-4726
(817) 251-7995
(817) 398-0016
Mailing address
1100 N KIMBALL AVE STE 110, SOUTHLAKE, TX 76092-4726
(951) 956-8966
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
04/10/2023
Last updated
01/11/2024
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