Provider Demographics
NPI:1912291287
Name:HOUCK, KIMBERLY M (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:HOUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 WESLAYAN ST APT 1348
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6380
Mailing Address - Country:US
Mailing Address - Phone:310-913-4000
Mailing Address - Fax:
Practice Address - Street 1:6701 FANNIN ST STE 950
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2611
Practice Address - Country:US
Practice Address - Phone:832-822-5046
Practice Address - Fax:832-825-3504
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ85092084E0001X, 2084N0402X
TXBP10039700390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10039700OtherTEXAS MEDICAL BOARD PHYSICIAN IN TRAINING PERMIT
TXQ8509OtherTEXAS MEDICAL BOARD