Provider Demographics
NPI:1851993828
Name:KYLE, SHAWNEE POWERS (ADRN)
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:POWERS
Last Name:KYLE
Suffix:
Gender:F
Credentials:ADRN
Other - Prefix:
Other - First Name:SHAWNEE
Other - Middle Name:MARIE
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADRN
Mailing Address - Street 1:4077 SAGE SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5370
Mailing Address - Country:US
Mailing Address - Phone:208-241-1837
Mailing Address - Fax:
Practice Address - Street 1:152 2ND AVE S
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6201
Practice Address - Country:US
Practice Address - Phone:208-241-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID48250163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse