Provider Demographics
NPI:1487955183
Name:HOUK, KELLY MICHAEL (BA BHT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHAEL
Last Name:HOUK
Suffix:
Gender:M
Credentials:BA BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 S VUELTA SILUETA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-8499
Mailing Address - Country:US
Mailing Address - Phone:520-318-4882
Mailing Address - Fax:
Practice Address - Street 1:7120 S VUELTA SILUETA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-8499
Practice Address - Country:US
Practice Address - Phone:520-318-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider