Healthcare Provider Details

I. General information

NPI: 1164369682
Provider Name (Legal Business Name): SALLY KATHRYN HOUK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 E SUMMERSWEET DR
BOISE ID
83716-6695
US

IV. Provider business mailing address

2051 E SUMMERSWEET DR
BOISE ID
83716-6695
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-3767
  • Fax:
Mailing address:
  • Phone: 208-323-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number75200
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: