Individual provider Active NPI

Sukeshini P Kelly, RN

  • Maternal Newborn Registered Nurse
  • Colton, CA
National Provider Identifier
1063610590
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal Newborn Registered NurseTaxonomy code 163WM0102X
License
482520 Issued in CA
Practice address
2033 E Colunga St
Colton, CA 92324-7510
Phone
(909) 872-1113
Fax
(909) 872-1113
NPI assigned
Jul 5, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 482520 CA
Case Management Registered Nurse 163WC0400X 482520 CA
Cardiac Rehabilitation Registered Nurse 163WC3500X 482520 CA
Emergency Registered Nurse 163WE0003X 482520 CA
Maternal Newborn Registered Nurse 163WM0102X 482520 CA Primary
Neonatal Intensive Care Registered Nurse 163WN0002X 482520 CA
Urology Registered Nurse 163WU0100X 482520 CA
Wound Care Registered Nurse 163WW0000X 482520 CA
Ostomy Care Registered Nurse 163WX1500X 482520 CA

Addresses

Primary practice location

2033 E Colunga St
Colton, CA 92324-7510

Mailing address

2033 E Colunga St
Colton, CA 92324-7510
Phone (909) 872-1113

Other identifiers 2

IdentifierTypeStateIssuer
EPS016950MedicaidCA
RVN005060MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
482520CAMDUrology Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1063610590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2033 E COLUNGA ST",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923247510",
            "telephone_number": "909-872-1113",
            "fax_number": "909-872-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 E COLUNGA ST",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923247510",
            "telephone_number": "909-872-1113",
            "fax_number": "909-872-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SUKESHINI",
        "middle_name": "P",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-05",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "CA",
            "license": "482520",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "CA",
            "license": "482520",
            "primary": false
        },
        {
            "code": "163WC3500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": "CA",
            "license": "482520",
            "primary": false
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "CA",
            "license": "482520",
            "primary": false
        },
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "CA",
            "license": "482520",
            "primary": true
        },
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "CA",
            "license": "482520",
            "primary": false
        },
        {
            "code": "163WU0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Urology",
            "state": "CA",
            "license": "482520",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "CA",
            "license": "482520",
            "primary": false
        },
        {
            "code": "163WX1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ostomy Care",
            "state": "CA",
            "license": "482520",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EPS016950",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RVN005060",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.