Provider Demographics
NPI:1922684067
Name:SHAVER, KYLA ASHLEY (FNP)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:ASHLEY
Last Name:SHAVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:ASHLEY
Other - Last Name:KNOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:102 W INDIAN ROCKS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4981
Mailing Address - Country:US
Mailing Address - Phone:530-966-4407
Mailing Address - Fax:
Practice Address - Street 1:3520 E LOUISE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6304
Practice Address - Country:US
Practice Address - Phone:208-888-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54466363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner