NPI age
5 years
Enumerated 2021-04-08
● Active Type 2 · Organization
Boise Ketamine Clinic
Boise Ketamine Clinic is 1 of 4 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Bailey
Owner
Last NPPES update
2021-04-08
Source: monthly bulk 2026-05
How this organization compares
Across 4 active clinic/center providers in Idaho.
NPI age
5 years
≈ at median (4 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2021 → 2026
2021-04Enumerated in NPPES
2021
2026
Where they practice
Primary practice location
2800 W Overland Rd
Boise, ID 837053038
Mailing address
2800 W Overland Rd
Boise, ID 837053038
Authorized official
Nykol Bailey, CRNA
Owner
📞 2088011414
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Mary Derlacki, FNP Internal Medicine NPI 1609947431
- Christa Whalen, FNP-BC Nurse Practitioner NPI 1881434595
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.