Katie Diana Waites, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1501 Issued in ID

Practice address

701 E Parkcenter Blvd
Boise, ID 83706-6528

Phone

(208) 381-4210

Fax

(208) 381-2045

NPI assigned

Mar 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Katie Diana Mallaburn Former name

Medicare fee-for-service enrollment

Enrolled in ID, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  Medicare reassignment Care Compare group NPD
• Tellica Imaging, LLC

  • Radiology Clinic/Center
  • Boise, ID
  • NPI 1760197198
  Medicare reassignment NPD
• Solantic of Jacksonville, LLC

  • Urgent Care Clinic/Center
  • Ponte Vedra, FL
  • NPI 1407893100
  Medicare reassignment
• Tellica Imaging, LLC

  • Physiological Laboratory
  • Spanish Fork, UT
  • NPI 1518727734
  NPD
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1306964994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066528",
            "telephone_number": "208-381-4210",
            "fax_number": "208-381-2045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "275 S Aspen St Stop 89",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800119562",
            "country_code": "US",
            "telephone_number": "720-277-9493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAITES",
        "first_name": "KATIE",
        "middle_name": "DIANA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "MALLABURN",
            "middle_name": "DIANA",
            "prefix": "MISS",
            "credential": "EMT-P, PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jade Anne Wahnschaffe, PHARMD
• Kennedy Kambo Wainaina, PHARM D
• Melissa M. Waine-Cunliffe, OT
• Glenn R. Waite, M.D.
• Janice Louise Waite, P.T.
• Wal-Mart Stores, Inc
• Wal-Mart Stores, Inc
• Laura Elizabeth Walawender, M.D.
• Christina Marie Wald, LMSW
• David A Wald, MD

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.