Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

QUAD CITIES KETAMINE CLINIC
NPI 1629781935
Nurse Practitioner in Davenport, IA

Q: What is Quad Cities Ketamine Clinic's NPI number?

The NPI number for Quad Cities Ketamine Clinic is 1629781935. It was assigned to this organization in the NPPES registry on January 2, 2023. The provider is doing business as Quad Cities Ketamine & Wellness Clinic.

Q: What is Quad Cities Ketamine Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since January 02, 2023

4622 PROGRESS DR STE A, DAVENPORT, IA 52807(563) 214-1594(563) 293-2803 Get Directions Write a Review

NPPES record last updated: October 13, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 13, 2026, Oct 3, 2024, Jan 2, 2023 (3 updates tracked since 2023).

On this page

About Quad Cities Ketamine Clinic NPPES

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

QUAD CITIES KETAMINE CLINIC (NPI 1629781935), doing business as Quad Cities Ketamine & Wellness Clinic, is a healthcare organization registered as a nurse practitioner in Davenport, Iowa and active in the NPI registry since January 2023. The organization lists Tara M Kinney, Owner, as its authorized official.

NPPES Registry Identity

NPI1629781935

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NameQUAD CITIES KETAMINE CLINIC

Location Address4622 PROGRESS DR STE ADavenport, IA 52807-3426

Mailing Address4622 Progress Dr Ste ADavenport, IA 52807-3426 · (563) 214-1594 · Fax (563) 293-2803

Phone(563) 214-1594

Fax(563) 293-2803

Organization SubpartNo

Authorized OfficialTara M KinneyOwner · (563) 214-1594

Enumeration DateJanuary 2, 2023

Last NPPES UpdateOctober 13, 20263 updates tracked since enumeration

NPPES CertifiedOctober 13, 2026

✔ NPI 1629781935 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X

4622 PROGRESS DR STE A, Davenport, IA 52807

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Other Names 1

Doing Business AsQuad Cities Ketamine & Wellness Clinic

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Quad Cities Ketamine Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Quad Cities Ketamine Clinic, which bills Medicare for the services this clinician delivers.

Clinician (1)

Nicole Matthys, ARNP

Nurse Practitioner

NPI 1477019511

3009 SHERIDAN ST
Davenport, IA 52803

(563) 320-6241

✔ PECOS✔ Accepts Medicare3.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Quad Cities Ketamine Clinic's NPI number?

The NPI number for Quad Cities Ketamine Clinic is 1629781935. It was assigned to this organization in the NPPES registry on January 2, 2023. The provider is doing business as Quad Cities Ketamine & Wellness Clinic.

Where is Quad Cities Ketamine Clinic located?

Quad Cities Ketamine Clinic is located at 4622 Progress Dr Ste A, Davenport, IA 52807. The listed phone number is (563) 214-1594.

What is Quad Cities Ketamine Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Quad Cities Ketamine Clinic enrolled in Medicare?

Yes. Quad Cities Ketamine Clinic is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Quad Cities Ketamine Clinic?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Quad Cities Ketamine Clinic. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Quad Cities Ketamine Clinic was last updated on October 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 days 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.