Provider Demographics
NPI:1427196658
Name:HOUCK, KELLY SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SUZANNE
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:PO BOX 33605
Mailing Address - Street 2:
Mailing Address - City:FORT LEWIS
Mailing Address - State:WA
Mailing Address - Zip Code:98433-0605
Mailing Address - Country:US
Mailing Address - Phone:423-676-8870
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:9040A FITZSIMMONS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-967-3096
Practice Address - Fax:253-967-3096
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAMD01012369242084P0800X
VA0101236924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry