Illuminate Wellness Center

LBN: Illuminate Ketamine Center Pllc
Illuminate Wellness Center is an health care organization with primary practice located at 1936 Brookside Dr Ste E , Kingsport TN 37660-4654. The organization recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Marriage & Family Therapist, Ambulatory Health Care Facilities / Infusion Therapy, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is the primary health care specialty. Illuminate Ketamine Center Pllc can be contacted via phone (423) 765-0777, or through Beasley, Shelia via phone (423) 765-0777.

Contact Information

Primary practice address
1936 Brookside Dr Ste E Kingsport TN 37660-4654
Phone: (423) 765-0777
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Beasley, Shelia Certified Registered Nurse Anesthetist (CRNA)
Phone: (423) 765-0777

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X
Ambulatory Health Care Facilities / Infusion Therapy 261QI0500X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X

Profile Details

NPI number 1649833062
LBN Legal business name Illuminate Ketamine Center Pllc
DBA Doing business as Illuminate Wellness Center
Authorized official Beasley, Shelia Certified Registered Nurse Anesthetist (CRNA)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 22nd, 2019
Last updated Mar 3rd, 2021 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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