Las Vegas Ketamine LLC
Nurse Practitioner, Psych/Mental Health in Las Vegas, NV. Organization (NPI-2).
NPI number1710696877
StatusActive
Last updated in NPPESMay 22, 2026
Details
- NPI
- 1710696877
- Entity type
- Organization (NPI-2)
- Legal business name
- Las Vegas Ketamine LLC
- Organization subpart
- No
- Enumeration date
- Nov 17, 2022
- Certification date
- May 22, 2026
- Last updated
- May 22, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
| 207L00000X | Anesthesiology | – | – |
Practice location
7390 W Sahara Ave Ste 270Las Vegas, NV 89117-2765
Phone 702-957-0468
Mailing address
5519 Bruin Lakes StLas Vegas, NV 89131-5921
Phone 229-412-5844
Authorized official
Adam C Fisher
Owner/Manager
2294125844
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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