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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

Active since January 02, 2023
4626 PROGRESS DR STE A, DAVENPORT, IA 52807(563) 214-1594(563) 293-2803 Get Directions Write a Review

NPPES record last updated: June 18, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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

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 Address4626 PROGRESS DR STE ADavenport, IA 52807-3485
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 UpdateJune 18, 20262 updates tracked since enumeration
NPPES CertifiedJune 18, 2026
✔ NPI 1629781935 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
4626 PROGRESS DR STE A, Davenport, IA 52807
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Other Names 1

Doing Business AsQuad Cities Ketamine & Wellness Clinic

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 4626 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.

When was this NPI record last updated?

The NPPES record for Quad Cities Ketamine Clinic was last updated on June 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 51 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.