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

Revive Ketamine Clinic, PLLC

Organization Medical Specialty Clinic/Center · NPI 1053984484

Revive Ketamine Clinic, PLLC is a Medical Specialty Clinic/Center in Bartlett, Tennessee. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
2
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

5820 Stage Rd
Bartlett, TN 38134-4518
Phone: (901) 317-7900
Fax: (901) 317-7899
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Specialty Clinic/Center (primary) Taxonomy 261QM2500X
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X

Record details

NPI number1053984484
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ginger Williams — Owner/Practitioner · (901) 317-7900
NPI enumeratedJuly 22, 2021
Last updated in NPPESApril 15, 2024
Certification dateApril 15, 2024
Mailing address5820 Stage Rd, Bartlett, TN 38134-4518