Healthcare Provider Details

I. General information

NPI: 1942116306
Provider Name (Legal Business Name): KILEE SHADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 GOLDENROD LN
LINCOLN NE
68512-1321
US

IV. Provider business mailing address

4703 GOLDENROD LN
LINCOLN NE
68512-1321
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-0311
  • Fax:
Mailing address:
  • Phone: 402-742-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH14058184
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: