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General NPI Number Information
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NPI Number | 1386987055
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Entity Type | Individual
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Provider Name | KATHERINE WINGATE QUAYLE
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Gender | Female
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1450 AVIATION DR STE 202
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City | HAILEY
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State | ID
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Zip | 83333-8785
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Country | US
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Telephone | 208-727-8970
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Fax | 208-727-8979
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 57.252141
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M-14263
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9148249-1205
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License Number State | UT
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