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NPI Code Detail

MEDICARE: KAITYLN SHEPHERD

MEDICARE: KAITYLN SHEPHERD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1194307744
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITYLN SHEPHERD
Provider Business Mailing Address
First Line : 4232 N WATERFORD PL
Second Line :
City : BOISE
State : ID
Zip : 83703-3490
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4232 N WATERFORD PL
Second Line :
City : BOISE
State : ID
Zip : 83703-3490
Country : US
Telephone Number : 312-965-2997
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2021
Last Update Date : 04/23/2021

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Directions to “ KAITYLN SHEPHERD ” Practice Location

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