Individual
BRADY KYLE SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
Mailing address
3443 W HAMM LN, HERRIMAN, UT 84096-2110
(801) 885-1570
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10256717-3102
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
78781
ID
Other
Enumeration date
01/09/2024
Last updated
03/08/2024
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