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

Jennifer Ann Shade

Individual provider Primary Care Nurse Practitioner · NPI 1922645696

Jennifer Ann Shade is a Primary Care Nurse Practitioner in Kingman, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2019

Practice location Address checks out

1740 E Beverly Ave Ste B
Kingman, AZ 86409-3564
Phone: (928) 263-1335
Fax: (928) 272-0173
Show map & directions

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

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence RN164008 (AZ)

Record details

NPI number1922645696
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedDecember 2, 2019
Last updated in NPPESMarch 16, 2024
Certification dateMarch 16, 2024
Mailing address1740 E Beverly Ave Ste B, Kingman, AZ 86409-3564

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