Keariesha Natalee Addison Samuels

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

95029249 Issued in 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

Last updated

Aug 12, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15691/brand/4/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elica Health Centers

  • Federally Qualified Health Center (FQHC)
  • West Sacramento, CA
  • NPI 1548425853
  Medicare reassignment NPD
• Golden Valley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Turlock, CA
  • NPI 1356445753
  Medicare reassignment NPD
• Elica Health Centers

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1093974065
  NPD
• Elica Health Centers

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1760293351
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1508464116
  NPD
• Golden Valley Health Centers

  dba GVHC Pharmacy

  • Community/Retail Pharmacy
  • Merced, CA
  • NPI 1093817405
  NPD
• Innova Pharmacy II

  • Community/Retail Pharmacy
  • Sacramento, CA
  • NPI 1124647011
  NPD

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

{
    "created_epoch": "1702339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1124895958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 SW 173RD WAY",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330292605",
            "telephone_number": "786-267-4646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 CADILLAC DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958258337",
            "telephone_number": "916-569-8484",
            "fax_number": "916-457-2667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "737 W Childs Ave",
            "address_purpose": "LOCATION",
            "city": "Merced",
            "state": "CA",
            "postal_code": "953416805",
            "country_code": "US",
            "telephone_number": "209-906-2917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDISON SAMUELS",
        "first_name": "KEARIESHA",
        "middle_name": "NATALEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-12",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11030106",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95029249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Adcox, LCSW
• Tyler Addams
• Sindhu Addepalli, MD
• Renae Addington, R.D.N.
• Rikke Blom Addis
• Joseph Adducci, PA-C
• Addus Healthcare, Inc. (Addus Home Care)
• Kafayat Adeoti Adebiyi
• Oyindamola Tolulope Adedipe, MS
• Adeela N. Ansari M.D., Inc.

• Primary Care Nurse Practitioner in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.