1. Home
  2. Directory
  3. Arizona
  4. Flagstaff
  5. Clinic Center
  6. NPI Profile

REVITALIZE KETAMINE CLINIC LLC
NPI 1346911195
Clinic/Center - Multi-Specialty in Flagstaff, AZ

Active since September 22, 2021
1800 S MILTON RD STE 26, FLAGSTAFF, AZ 86001(928) 213-6931 Get Directions Write a Review

NPPES record last updated: September 22, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Revitalize Ketamine Clinic Llc NPPES

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

REVITALIZE KETAMINE CLINIC LLC (NPI 1346911195) is a healthcare organization registered as a multi-specialty in Flagstaff, Arizona and active in the NPI registry since September 2021. The organization lists Jill Michelle Dubravcic, Owner/operator, as its authorized official.

NPPES Registry Identity

NPI1346911195
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameREVITALIZE KETAMINE CLINIC LLC
Location Address1800 S MILTON RD STE 26Flagstaff, AZ 86001-6340
Mailing Address1800 S Milton Rd Ste 26Flagstaff, AZ 86001-6340
Phone(928) 213-6931
Organization SubpartNo
Authorized OfficialJill Michelle DubravcicOwner/operator · (928) 213-6931
Enumeration DateSeptember 22, 2021
NPPES CertifiedJuly 13, 2021
✔ NPI 1346911195 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
1800 S MILTON RD STE 26, Flagstaff, AZ 86001
Open in Google Maps ↗

Other Names 1

Other NameRevketa

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 Revitalize Ketamine Clinic LLC's NPI number?

The NPI number for Revitalize Ketamine Clinic LLC is 1346911195. It was assigned to this organization in the NPPES registry on September 22, 2021. The provider is also known as Revketa.

Where is Revitalize Ketamine Clinic LLC located?

Revitalize Ketamine Clinic LLC is located at 1800 S Milton Rd Ste 26, Flagstaff, AZ 86001. The listed phone number is (928) 213-6931.

What is Revitalize Ketamine Clinic LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

When was this NPI record last updated?

The NPPES record for Revitalize Ketamine Clinic LLC was last updated on September 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.