CLINIC KETAMINE, P.C. (NPI# 1669005336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669005336 |
| Entity Type | Organization |
| Organization Name | CLINIC KETAMINE, P.C. |
| Other Organization Name | COMPREHENSIVE PAIN MANAGEMENT SERVICES |
| Practice Address |
70 Meadow St Lyman WY 82937-9008 |
| Mailing Address |
Po Box 2669 Rock Springs WY 82902-2669 |
| Practice Telephone | 8006641539 |
| Practice Fax Number | 3074484666 |
| Mailing Telephone | 8006641539 |
| Mailing Fax Number | 3074484666 |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2020-02-20 |
| Authorized Official Name | JOHN CHRISTOPHER KIPPLE (PRESIDENT) |
| Authorized Official Telephone | 8006641539 |
| Authorized Official Credential | APRN, CRNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Comprehensive Pain Management Services | Doing Business As Name - Organization |
| Street Address |
70 MEADOW ST |
| City | LYMAN |
| State | WY |
| Zip Code | 82937-9008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609417088 | Valley Counseling & Coaching LLC | Social Worker | 109 S. Main St. Suite D, Lyman, WY 82937 | 2019-10-07 |
| 1912462326 | South Lincoln Hospital District | Pharmacy | 2822 Wy 414, Lyman, WY 82937 | 2019-02-11 |
| 1023585775 | Autumn Spann | Behavior Technician | 210 Aspen St, Urie, WY 82937 | 2018-10-31 |
| 1821472903 | Cowboy Cares, Inc. | Home Health | 70 Meadow Street, Lyman, WY 82937 | 2015-07-17 |
| 1952729857 | Bridger Valley Urgent Care, LLC | Emergency Medicine | 3580 State Highway 414, Lyman, WY 82937 | 2014-03-29 |
| 1124442249 | Auralcare Hearing Centers of America, LLC | Clinic/Center | 106 S Main Street, 1, Lyman, WY 82937 | 2014-02-10 |
| 1760668362 | Jason R. Haycock | Chiropractor | 225 W Owen St., Lyman, WY 82937 | 2008-01-14 |
| 1205977006 | Ashby Wood Tippets | Dentist | 37 Mt. Meadow St., Suite C, Lyman, WY 82937 | 2007-02-12 |
| 1588757041 | Lynn J Clifford | Dentist | 37 Meadow St, #11, Lyman, WY 82937 | 2006-10-02 |
| 1639184096 | Randall Carter Christopherson | Physical Therapist | 109 South Main St., Suite D, Lyman, WY 82937 | 2006-07-31 |
| Find all providers in zip 82937 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467922468 | Cloud Peak Anesthesia, LLC | Nurse Anesthetist, Certified Registered | 1307 W 3rd St Ste B, Gillette, WY 82716-3343 | 2018-12-03 |
| 1548794340 | Amber Knuths | Nurse Anesthetist, Certified Registered | 4514 Running W Dr, Apartment 303, Gillette, WY 82718-2025 | 2017-04-18 |
| 1285972737 | Amanda Raye Zuck | Nurse Anesthetist, Certified Registered | 3100 W Lakeway Rd Ste 3, Gillette, WY 82718-6373 | 2013-01-17 |
| 1912298530 | Justin R Fenus | Nurse Anesthetist, Certified Registered | 190 Seminole Dr, Evanston, WY 82930-6600 | 2011-04-30 |
| 1083785281 | Richard Carver | Nurse Anesthetist, Certified Registered | 195 Overthrust Rd., Evanston, WY 82930-9266 | 2006-11-11 |
| 1104917558 | Jeffrey L Green | Nurse Anesthetist, Certified Registered | 1524 W 5th St, Sheridan, WY 82801-2707 | 2006-09-28 |
| 1831280221 | Shauna R Kohler | Nurse Anesthetist, Certified Registered | 111 S 5th Street, Douglas, WY 82633 | 2006-09-28 |
| 1558396911 | Gary Max Hess | Nurse Anesthetist, Certified Registered | Star Valley Medical Center, 110 Hospital Lane, Afton, WY 83110 | 2006-07-12 |
| 1316979057 | William David Hamilton | Nurse Anesthetist, Certified Registered | 625 East Broadway, Jackson, WY 83001 | 2006-07-06 |
| 1356372726 | /cynthia Ann French | Nurse Anesthetist, Certified Registered | 625 E Broadway St Johns Medical Center, Jackson, WY 83001 | 2006-07-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.