Healthcare Provider Details

I. General information

NPI: 1992059125
Provider Name (Legal Business Name): CINDY KAY HORROCKS RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CURTIS RD SUITE 305
BOISE ID
83706-1337
US

IV. Provider business mailing address

1000 N CURTIS RD SUITE 305
BOISE ID
83706-1337
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-7382
  • Fax: 208-367-7316
Mailing address:
  • Phone: 208-367-7382
  • Fax: 208-367-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-062
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: