NPIMap

Organization Active NPI

Hayden Lake Anesthesia PLLC

  • Certified Registered Nurse Anesthetist
  • Hayden, ID
National Provider Identifier
1134926181
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
HAYDEN LAKE ANESTHESIA PLLC
Practice address
8552 N Government Way
Hayden, ID 83835-9280
Phone
(208) 660-3604
NPI assigned
Feb 27, 2025
Last updated
Feb 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kyle Thomas Shibley, CRNANPI 1417449380
Title
Managing Partner
Phone
(208) 209-6804

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary

Addresses

Primary practice location

8552 N Government Way
Hayden, ID 83835-9280

Mailing address

PO Box 295
Hayden, ID 83835-0295
Phone (208) 209-6804

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250423002099 ID Part B Supplier - Clinic/Group Practice 1759806623 Receives reassigned benefits from 7 practitioners
Practice locations: Hayden, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1134926181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 295",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838350295",
            "telephone_number": "208-209-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8552 N GOVERNMENT WAY",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359280",
            "telephone_number": "208-660-3604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYDEN LAKE ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-27",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "SHIBLEY",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "208-209-6804",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.