Provider Demographics
NPI:1427844653
Name:TENNESSEE KETAMINE & THERAPEUTICS
Entity type:Organization
Organization Name:TENNESSEE KETAMINE & THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-304-9622
Mailing Address - Street 1:718 W LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3943
Mailing Address - Country:US
Mailing Address - Phone:865-304-9622
Mailing Address - Fax:
Practice Address - Street 1:718 W LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3943
Practice Address - Country:US
Practice Address - Phone:865-233-6188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)