Provider Demographics
NPI:1295909794
Name:QUARLES, LEIGHANNE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LEIGHANNE
Middle Name:
Last Name:QUARLES
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 S 100 W
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9719
Mailing Address - Country:US
Mailing Address - Phone:801-201-0004
Mailing Address - Fax:866-503-6022
Practice Address - Street 1:198 S 100 W
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9719
Practice Address - Country:US
Practice Address - Phone:801-201-0004
Practice Address - Fax:866-503-6022
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60577683363LP0808X
AZAP7915363LP0808X
COC-APN-0000474-C-NP363LP0808X
OR201603563NP-PP363LP0808X
VA0024175161363LP0808X
UT5304594-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1295909794Medicaid
WA1295909794Medicaid