Provider Demographics
NPI:1972906824
Name:SKELLY, KATHERINE (PA)
Entity Type:Individual
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First Name:KATHERINE
Middle Name:
Last Name:SKELLY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:413 N ALLUMBAUGH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9212
Mailing Address - Country:US
Mailing Address - Phone:208-323-1125
Mailing Address - Fax:208-323-9604
Practice Address - Street 1:413 N ALLUMBAUGH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9212
Practice Address - Country:US
Practice Address - Phone:208-323-1125
Practice Address - Fax:208-323-9604
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDGPA-057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant