MEDICARE: KIMBERLY M HOUCK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084E0001X	Epilepsy Physician	Q8509	TX
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	Q8509	TX
3	390200000X	Student in an Organized Health Care Education/Training Program	BP10039700	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BP10039700	OTHER	TX	TEXAS MEDICAL BOARD PHYSICIAN IN TRAINING PERMIT
2	Q8509	OTHER	TX	TEXAS MEDICAL BOARD

General Provider Information

NPI Number	:	1912291287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M HOUCK M.D.

Provider Business Mailing Address
First Line	:	3333 WESLAYAN ST APT 1348
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6380
Country	:	US
Telephone Number	:	310-913-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 FANNIN ST STE 950
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2611
Country	:	US
Telephone Number	:	832-822-5046
Fax Number	:	832-825-3504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	09/16/2024

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Directions to “ KIMBERLY M HOUCK M.D.” Practice Location

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