Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Brady Kyle Shepherd

Individual provider Registered Nurse · NPI 1093586158

Brady Kyle Shepherd is a Certified Registered Nurse Anesthetist (CRNA) in Pocatello, Idaho. Qualified in 2023, 3 years ago. Practices with Northstar Anesthesia of Idaho PLLC, a 39-clinician group and accepts Medicare assignment. Licensed in Idaho and Utah.

Years since qualifying
3
Licensed in
ID, UT
In the registry since
2024
Specialties on file
2
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Practice location Address checks out

777 Hospital Way
Pocatello, ID 83201-5175
Phone: (208) 239-1000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 78781 (ID)
Registered Nurse Taxonomy 163W00000X · Licence 10256717-3102 (UT)

Record details

NPI number1093586158
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 9, 2024
Last updated in NPPESMarch 8, 2024
Certification dateMarch 8, 2024
Mailing address3443 W Hamm Ln, Herriman, UT 84096-2110

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Northstar Anesthesia Of Idaho Pllc — 39 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Pocatello