Individual provider Active NPI

Holly Bukky

  • Community Health Worker
  • Boise, ID
National Provider Identifier
1649147703
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
545 N Benjamin LN Ste 185
Boise, ID 83704-9625
Phone
(208) 322-1026
Fax
(208) 322-1029
NPI assigned
Oct 22, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Community Health Worker 172V00000X Primary
Case Management Agency 251B00000X
Peer Specialist 175T00000X

Addresses

Primary practice location

545 N Benjamin LN Ste 185
Boise, ID 83704-9625

Mailing address

545 N Benjamin LN Ste 185
Boise, ID 83704-9625
Phone (208) 322-1026

Other practice location 1

413 W Idaho St Ste 302
Boise, ID 83702-6066
Phone (208) 385-7233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tanta Inc Community/Behavioral Health PastSince Nov 24, 2024 Accepting new patients
Safe Connections, LLC. Community/Behavioral Health PastSince Nov 24, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777248000000",
    "number": "1649147703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 N BENJAMIN LN STE 185",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049625",
            "telephone_number": "208-322-1026",
            "fax_number": "208-322-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 N BENJAMIN LN STE 185",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049625",
            "telephone_number": "208-322-1026",
            "fax_number": "208-322-1029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "413 W Idaho St Ste 302",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026066",
            "country_code": "US",
            "telephone_number": "208-385-7233",
            "fax_number": "208-344-7233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUKKY",
        "first_name": "HOLLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-22",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.