Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Active Ketamine, PLLC

Organization Pain Medicine (Psychiatry & Neurology) Physician · NPI 1073259156

Active Ketamine, PLLC is a Pain Medicine (Psychiatry & Neurology) Physician in Houston, Texas. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12250 Queenston Blvd Ste E
Houston, TX 77095-5343
Phone: (281) 201-4511
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pain Medicine (Psychiatry & Neurology) Physician (primary) Taxonomy 2084P2900X

Record details

NPI number1073259156
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jared Heathman — Managing Member · (281) 201-4511
NPI enumeratedMay 11, 2022
Last updated in NPPESMay 11, 2022
Certification dateMay 11, 2022
Mailing address12250 Queenston Blvd Ste E, Houston, TX 77095-5343

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