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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: August 09, 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 NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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 NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revive Ketamine Clinic, PLLC's NPI number?

The NPI number for Revive Ketamine Clinic, PLLC is 1053984484. It was assigned to this organization in the NPPES registry on July 22, 2021.

Where is Revive Ketamine Clinic, PLLC located?

Revive Ketamine Clinic, PLLC is located at 5820 Stage Rd, Bartlett, TN 38134. The listed phone number is (901) 317-7900.

What is Revive Ketamine Clinic, PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

When was this NPI record last updated?

The NPPES record for Revive Ketamine Clinic, PLLC was last updated on April 15, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.