Organization
BOISE KETAMINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NYKOL BAILEY CRNA (OWNER)
(208) 801-1414
Entity
Organization
Contact information
Practice address
2800 W OVERLAND RD, BOISE, ID 83705-3038
(208) 801-1414
(208) 207-2866
Mailing address
2800 W OVERLAND RD, BOISE, ID 83705-3038
(208) 801-1414
(208) 207-2866
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
04/08/2021
Last updated
04/08/2021
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