Provider Demographics
NPI:1245114834
Name:GARDEN PATH KETAMINE, PLLC
Entity type:Organization
Organization Name:GARDEN PATH KETAMINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LHUILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:919-341-6400
Mailing Address - Street 1:13122 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7930
Mailing Address - Country:US
Mailing Address - Phone:919-341-6400
Mailing Address - Fax:919-322-2201
Practice Address - Street 1:13122 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7930
Practice Address - Country:US
Practice Address - Phone:919-341-6400
Practice Address - Fax:919-322-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty