OrganizationActive
Active Ketamine, PLLC
NPI 1073259156 · Pain Medicine (Psychiatry & Neurology) Physician · Houston, TX
Provider details
- NPI number
- 1073259156
- Entity type
- Organization
- Primary specialty
- Pain Medicine (Psychiatry & Neurology) PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Jared Heathman, Managing Member
Practice location
12250 Queenston Blvd Ste E
Houston, TX 77095-5343
Phone: (281) 201-4511
Mailing address
12250 Queenston Blvd Ste E
Houston, TX 77095-5343
Registry dates
- Enumerated
- 2022-05-11
- Last updated
- 2022-05-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.