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

Kent Lyle Shippen, PA

Individual provider Physician Assistant · NPI 1942379003

Kent Lyle Shippen, PA is a Physician Assistant in Driggs, Idaho. Qualified in 2005, 21 years ago. Practices with Advanced Dermatology of Wyoming Inc, a 3-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
21
Licensed in
ID
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

283 N 1st E
Driggs, ID 83422-5109
Phone: (208) 354-2302
Fax: (208) 354-8392
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-617 (ID)

Record details

NPI number1942379003
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 6, 2006
Last updated in NPPESJuly 9, 2007

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Advanced Dermatology Of Wyoming Inc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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