Organization
AFFORDABLE KETAMINE CLINICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROYCE B BARTHOLOMEW CRNA (OWNER/MANAGER)
(801) 372-1888
Entity
Organization
Contact information
Practice address
375 N MAIN ST STE 202, KAYSVILLE, UT 84037-1278
(801) 450-7147
(385) 209-2975
Mailing address
375 N MAIN ST STE 202, KAYSVILLE, UT 84037-1278
(801) 450-7147
(385) 209-2975
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528884092034
—
UT
Enumeration date
01/09/2021
Last updated
01/09/2021
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