JENNIFER ANN SHADE (NPI# 1922645696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922645696 |
| Entity Type | Individual |
| Full Name | JENNIFER ANN SHADE |
| Other Name | JENNIFER ANN GIFFIN |
| Practice Address |
3269 N Stockton Hill Rd Kingman AZ 86409-3619 |
| Practice Telephone | 9287572101 |
| Mailing Telephone | 9287572101 |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
RN164008 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730577388 | Jennifer Shade | Registered Nurse | 16529 Coastal Hwy, Lewes, DE 19958-3696 | 2015-01-06 |
| 1801028600 | Jennifer Marie Shade | Ophthalmology | 89 Sylvania Dr, Beavercreek, OH 45440-3281 | 2009-08-13 |
| Street Address |
3269 N STOCKTON HILL RD |
| City | KINGMAN |
| State | AZ |
| Zip Code | 86409-3619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073510673 | Attiya Salim | Anesthesiology | 3269 N Stockton Hill Rd, Kingman, AZ 86401-3619 | 2005-06-28 |
| 1942809264 | Brittney Migliozzi | Pharmacist | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-10-19 |
| 1508489451 | Clarke Snodgrass | Student in an Organized Health Care Education/Training Program | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-05-27 |
| 1275155848 | Richard Hernandez | Technician/Technologist | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-05-17 |
| 1851920060 | Daniela Nicole La Delfa | Student in an Organized Health Care Education/Training Program | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-04-08 |
| 1992332647 | Dawn Beth Bowling | Student in an Organized Health Care Education/Training Program | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-03-24 |
| 1518594274 | John Joseph Scudiero | Student in an Organized Health Care Education/Training Program | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-03-24 |
| 1730715731 | Sarah Marie Zito | Student in an Organized Health Care Education/Training Program | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-03-21 |
| 1710526801 | Thomas Dee Bress | Counselor | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2020-01-06 |
| 1487297719 | Bradley Norman Rowden | Nurse Practitioner | 3269 N Stockton Hill Rd, Kingman, AZ 86409-3619 | 2019-10-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437695731 | Medical Laboratory Specialty, Inc | Clinical Medical Laboratory | 3636 St, Kingman, AZ 86409 | 2017-01-10 |
| 1003219007 | Premier Home Health Agency | Home Health | 3555 Western Ave, Kingman, AZ 86409 | 2014-10-03 |
| 1558774984 | Fernando Velez | Pharmacist | 2003 Roy Rogers Way, Kingman, AZ 86409 | 2014-06-03 |
| 1013227834 | Route 66 Cab Inc | Taxi | 3595 E Us Highway 66, Kingman, AZ 86409 | 2010-10-14 |
| 1740503374 | Route 66 Cab Inc. | Taxi | 3595 East Hwy 66, Kingman, AZ 86409 | 2010-03-10 |
| 1649409145 | Arizona Cvs Stores, L.L.C. | Durable Medical Equipment & Medical Supplies | 3501 Stockton Hill Rd, Kingman, AZ 86409 | 2009-07-07 |
| 1790922896 | Jack Cheng-tsung Hou | Urology | 1739 E Beverly Ave Ste 106, Kingman, AZ 86409 | 2009-01-12 |
| 1710184726 | Michele F Epstein | Internal Medicine | 3571 N Moore Street, Kingman, AZ 86409 | 2007-07-02 |
| 1013118306 | Conchita O Mercado | Dentist | 1101 Riata Valley Rd, Kingman, AZ 86409 | 2007-05-31 |
| 1366585945 | Deering Therapy Services Ltd | Occupational Therapist | 1841 Morrow Ave, Kingman, AZ 86409 | 2007-02-14 |
| Find all providers in zip 86409 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306367842 | Jillian Marie Musick | Nurse Practitioner | 1111 Riata Valley Rd Ste B, Kingman, AZ 86409-3678 | 2017-07-06 |
| 1801383963 | Kathleen B Walton | Nurse Practitioner | 3636 N Stockton Hill Rd, Kingman, AZ 86409-0514 | 2018-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447864202 | Soma Care, LLC | Nurse Practitioner | 6944 E Broadway Rd Ste A, Mesa, AZ 85208-1916 | 2020-08-31 |
| 1497367403 | Daryl Lyons | Nurse Practitioner | 18095 W Santa Irene Dr, Goodyear, AZ 85338-5456 | 2020-08-20 |
| 1538787072 | Brijeshaben Urvish Patel | Nurse Practitioner | 13300 N 88th Ave Apt 2007, Peoria, AZ 85381-2614 | 2020-07-10 |
| 1043835424 | Us Live Clinic LLC | Nurse Practitioner | 12610 E Laurel Ln, Scottsdale, AZ 85259-3460 | 2020-06-11 |
| 1831713148 | Alexis Petra Md | Nurse Practitioner | 21835 N 51st St, Phoenix, AZ 85054-7140 | 2020-06-02 |
| 1245851955 | Amy Rachelle Dunn | Nurse Practitioner | 7563 E Plata Ave, Mesa, AZ 85212-9729 | 2020-05-04 |
| 1700407426 | Joan N Nunoo | Nurse Practitioner | 3852 E Santa Fe Ln, Gilbert, AZ 85297-8529 | 2020-05-04 |
| 1326675166 | Kendrick Wright | Nurse Practitioner | 2727 E Camelback Rd Apt 525, Phoenix, AZ 85016-4481 | 2020-03-23 |
| 1518591510 | Laura Larson | Nurse Practitioner | 1929 W Fillmore St Bldg C, Phoenix, AZ 85009-3812 | 2020-02-27 |
| 1538791512 | Silverleaf Health LLC | Nurse Practitioner | 20715 N Pima Rd Ste 108, Scottsdale, AZ 85255-6685 | 2020-02-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.