Healthcare Provider Details

I. General information

NPI: 1821920182
Provider Name (Legal Business Name): SHEPHERD VITALITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S CLEARWATER LOOP STE B
POST FALLS ID
83854-9599
US

IV. Provider business mailing address

784 S CLEARWATER LOOP STE B
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 208-971-5035
  • Fax: 208-279-7585
Mailing address:
  • Phone: 208-971-5035
  • Fax: 208-279-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA TITCHENAL
Title or Position: PRACTICE OWNER / NP
Credential: AGNP-C
Phone: 208-971-5035