Healthcare Provider Details

I. General information

NPI: 1538080742
Provider Name (Legal Business Name): TEDY OKECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9428 W FAIRVIEW AVE
BOISE ID
83704-8101
US

IV. Provider business mailing address

2010 S HUDSON AVE APT D203
BOISE ID
83705-4351
US

V. Phone/Fax

Practice location:
  • Phone: 986-301-0460
  • Fax: 208-277-3595
Mailing address:
  • Phone: 986-301-0460
  • Fax: 208-277-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number172V00000X
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: