Organization
KETAMINE WELLNESS CENTERS DFW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA D JERGER (EXECUTIVE ASSISTANT)
(855) 538-9355
Entity
Organization
Contact information
Practice address
6144 PRECINCT LINE RD STE 100, HURST, TX 76054-2610
(855) 538-9355
(844) 538-9355
Mailing address
6144 PRECINCT LINE RD STE 100, HURST, TX 76054-2613
(855) 538-9355
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
07/22/2019
Last updated
08/21/2020
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