Quad Cities Ketamine Clinic
NPI 1629781935ActiveOrganization· Nurse Practitioner· Davenport, IA
Nurse Practitioner in Davenport, Iowa, registered in NPPES in January 2023. The authorized official on file is Tara M. Kinney, CRNA, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1629781935 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 2, 2023 |
| Last updated in NPPES | Oct 13, 2026 |
| Certified by provider | Oct 13, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | — | — |
| Nurse Practitioner, Psych/Mental Health | 363LP0808X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IA) |
|---|
Other Nurse Practitioner providers in Davenport
- 1336957778
- 1457263063
- 1942676945
- 1215655568
- 1376258905
- 1467313148
- 1881224376
- 1689902579
- 1770033888
- 1285212548
- 1407653934
- 1427532803