Kelly Simone Stegall, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

724239 Issued in CA

Practice address

12927 Moreno Beach Dr Apt 5305
Moreno Valley, CA 92555-4451

Phone

(909) 441-6525

NPI assigned

Nov 18, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1668729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1295444172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12927 MORENO BEACH DR APT 5305",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925554451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12927 MORENO BEACH DR APT 5305",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925554451",
            "telephone_number": "909-441-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEGALL",
        "first_name": "KELLY",
        "middle_name": "SIMONE",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-18",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "724239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kstegall@hemetusd.org",
            "affiliation": "N",
            "address_1": "12927 Moreno Beach Dr Apt 5305",
            "city": "Moreno Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925554451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Licensed Vocational Nurse in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; 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.