ILLUMINATE KETAMINE CENTER PLLC NPI 1649833062

NPI Information

  • NPI: 1649833062
  • Provider Name: ILLUMINATE KETAMINE CENTER PLLC
  • Classification: Nurse Anesthetist, Certified Registered - 367500000X
  • Entity Type: Organization
  • Doing Business As: ILLUMINATE WELLNESS CENTER
  • Address: 1936 BROOKSIDE DR STE E
    KINGSPORT, TN
    ZIP 37660
  • Phone: (423) 765-0777

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NPI Details

ILLUMINATE KETAMINE CENTER PLLC is a nurse anesthetist certified registered in Kingsport, TN. The provider is (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. ILLUMINATE KETAMINE CENTER PLLC NPI is 1649833062. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Illuminate Wellness Center.

The provider's business location address is:

1936 BROOKSIDE DR STE E
KINGSPORT, TN
ZIP 37660-654
Phone: (423) 765-0777

The provider's authorized official is Shelia Beasley .
The authorized official title is Co-owner/ President and has the following contact phone number (423) 765-0777.

The enumeration date for this NPI number is 4/22/2019 and was last updated on 3/3/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)No
2101YM0800XCounselorMental HealthNo
3106H00000XMarriage & Family TherapistNo
4261QI0500XClinic/CenterInfusion TherapyNo
5367500000XNurse Anesthetist, Certified RegisteredYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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