Provider Demographics
NPI:1891588729
Name:KETAMINE SEATTLE, PLLC
Entity type:Organization
Organization Name:KETAMINE SEATTLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-998-5415
Mailing Address - Street 1:3800 AURORA AVE N STE 360
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8721
Mailing Address - Country:US
Mailing Address - Phone:503-998-5415
Mailing Address - Fax:
Practice Address - Street 1:3800 AURORA AVE N STE 360
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8721
Practice Address - Country:US
Practice Address - Phone:503-998-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty