Keariesha Natalee Addison Samuels
Individual provider Active NPI Primary Care Nurse Practitioner · Sacramento, CA
NPI 1124895958 · NPPES record last updated Aug 12, 2025
Key facts
- NPI
- 1124895958
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 95029249 (CA)
- Practice address
- 77 Cadillac Dr Ste 200
Sacramento, CA 95825-8337 - Phone
- (916) 569-8484
- Fax
- (916) 457-2667
- NPI assigned
- Dec 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240703002605 | CA | Practitioner - Nurse Practitioner | 2860936630 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11030106 | FL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elica Health Centers | Current |
Accepting new patients | |
| Golden Valley Health Centers | Current | Accepting new patients | |
| Elica Health Centers | Current | Accepting new patients | |
| Golden Valley Health Centers | Current |
Accepting new patients | |
| Elica Health Centers | Current |
Accepting new patients | |
| Golden Valley Health Center | Current |
Accepting new patients |
Locations
1910 Customer Care Way
Atwater, CA 95301
Phone (209) 384-6488
1405 California Ave
Dos Palos, CA 93620
Phone (209) 392-2111
13161 Jefferson St
Le Grand, CA 95333
Phone (209) 389-1900
821 Texas Ave
Los Banos, CA 93635
Phone (209) 385-5481
250 Northgate Dr
Manteca, CA 95336
Phone (209) 239-5299
797 W Childs Ave
Merced, CA 95341
Phone (209) 383-5871
737 W Childs Ave
Merced, CA 95341
Phone (209) 383-1848
3940 Sandpiper Ave
Merced, CA 95340
Phone (209) 381-4104
847 W Childs Ave
Merced, CA 95341
Phone (209) 383-7441
1114 6th St
Modesto, CA 95354
Phone (209) 576-2845
1121 Hammond St
Modesto, CA 95351
Phone (209) 576-4437
2101 Tenaya Dr
Modesto, CA 95354
Phone (209) 576-6766
1500 Florida Ave
Modesto, CA 95350
Phone (209) 571-5071
637 Merced St
Newman, CA 95360
Phone (209) 862-0270
200 C St
Patterson, CA 95363
Phone (209) 892-6307
9235 E Broadway St
Planada, CA 95365
Phone (209) 382-0253
4150 Patterson Rd
Riverbank, CA 95367
Phone (209) 863-3900
1750 Wright St
Ste 1
Sacramento, CA 95825
1860 Howe Ave
Ste 440
Sacramento, CA 95825
77 Cadillac Dr
Ste 200
Sacramento, CA 95825
Phone (916) 561-5911
3701 J St
Ste 101
Sacramento, CA 95816
Phone (916) 220-3344
1200 W Main St
Turlock, CA 95380
Phone (209) 668-5388
1276 Halyard Dr
West Sacramento, CA 95691
155 15th St
Ste A
West Sacramento, CA 95691
Phone (916) 375-8981
Interoperability endpoints
- https://api.platform.athenahealth.com/15691/brand/4/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11030106 | FL | |
| Primary Care Nurse Practitioner | 363LP2300X | 95029249 | CA | Yes |
Addresses
Primary practice location
77 Cadillac Dr Ste 200
Sacramento, CA 95825-8337
Mailing address
3375 SW 173Rd Way
Miramar, FL 33029-2605
Phone (786) 267-4646
Other practice location 1
737 W Childs Ave
Merced, CA 95341-6805
Phone (209) 906-2917
Other providers in Sacramento, CA
- Courtney Adcox
- Tyler Addams
- Sindhu Addepalli
- Renae Addington
- Rikke Blom Addis
- Joseph Adducci
- Addus Healthcare, Inc.
- Oyindamola Tolulope Adedipe
- Adeela N. Ansari M.D., Inc.
- Toris Natalie Adefunmi
All providers in Sacramento, CA · Primary Care Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.