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REVIVE KETAMINE CLINIC, PLLC
NPI 1053984484
Clinic/Center - Medical Specialty in Bartlett, TN

Active since July 22, 2021
5820 STAGE RD, BARTLETT, TN 38134(901) 317-7900(901) 317-7899 Get Directions Write a Review

NPPES record last updated: April 15, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Apr 15, 2024, Jul 22, 2021 (2 updates tracked since 2021).

About Revive Ketamine Clinic, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVE KETAMINE CLINIC, PLLC (NPI 1053984484) is a healthcare organization registered as a medical specialty in Bartlett, Tennessee and active in the NPI registry since July 2021. The organization lists Ginger Williams, Owner/practitioner, as its authorized official.

NPPES Registry Identity

NPI1053984484
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameREVIVE KETAMINE CLINIC, PLLC
Location Address5820 STAGE RDBartlett, TN 38134-4518
Mailing Address5820 Stage RdBartlett, TN 38134-4518 · (901) 317-7900 · Fax (901) 317-7899
Phone(901) 317-7900
Fax(901) 317-7899
Organization SubpartNo
Authorized OfficialGinger WilliamsOwner/practitioner · (901) 317-7900
Enumeration DateJuly 22, 2021
Last NPPES UpdateApril 15, 20242 updates tracked since enumeration
NPPES CertifiedApril 15, 2024
✔ NPI 1053984484 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X
5820 STAGE RD, Bartlett, TN 38134
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Other Providers at the Same Location


The following 2 providers are registered at the same or a nearby location.

DR. GINGER MARIE WILLIAMS CRNA, PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
5820 STAGE RD
BARTLETT, TN 38134
Shelby County (901) 317-7900
REVIVE BEHAVIORAL HEALTH CLINIC
Nurse Practitioner (Psychiatric/Mental Health)
5820 STAGE RD
BARTLETT, TN 38134
Shelby County (901) 317-7900

Frequently Asked Questions

What is REVIVE KETAMINE CLINIC, PLLC's NPI number?

The NPI number assigned to this healthcare provider is 1053984484, enumerated as an "organization" on July 22, 2021.

Where is the provider located?

The provider is located at 5820 STAGE RD BARTLETT, TN 38134 and the phone number is (901) 317-7900.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QM2500X and a focus in Medical Specialty.