Kenisha Akeila Nisbett, D.O.

Primary specialty

Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X

License

17194 Issued in CA

Practice address

1513 S Grand Ave Ste 200
Los Angeles, CA 90015-3075

Phone

(323) 438-0483

Fax

(310) 862-6817

NPI assigned

Apr 13, 2017

Last updated

May 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenishanisbett@wdsmdinc.allscriptsdirect.net

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.

• County of Butte

  • Adult Mental Health Clinic/Center
  • Chico, CA
  • NPI 1578623583
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• County of Butte

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Paradise, CA
  • NPI 1174161343
  NPD
• County of Butte

  • Adult Mental Health Clinic/Center
  • Chico, CA
  • NPI 1992248132
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Anaheim, CA
  • NPI 1952333460
  NPD

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1316471527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 S GREEN ST STE 5",
            "city": "TEHACHAPI",
            "state": "CA",
            "postal_code": "935611717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 S GRAND AVE STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153075",
            "telephone_number": "323-438-0483",
            "fax_number": "310-862-6817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43845 10th St W Ste 2D",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "CA",
            "postal_code": "935344800",
            "country_code": "US",
            "telephone_number": "760-951-0065",
            "fax_number": "760-951-5382",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "38920 Trade Center Dr",
            "address_purpose": "LOCATION",
            "city": "Palmdale",
            "state": "CA",
            "postal_code": "935513715",
            "country_code": "US",
            "telephone_number": "760-951-0065",
            "fax_number": "760-951-5382",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2150 N Waterman Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924044811",
            "country_code": "US",
            "telephone_number": "760-951-0065",
            "fax_number": "760-951-5382",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15030 7th St",
            "address_purpose": "LOCATION",
            "city": "Victorville",
            "state": "CA",
            "postal_code": "923953811",
            "country_code": "US",
            "telephone_number": "760-951-0065",
            "fax_number": "760-951-5382",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18056 Wika Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Apple Valley",
            "state": "CA",
            "postal_code": "923072194",
            "country_code": "US",
            "telephone_number": "760-951-0065",
            "fax_number": "760-951-5382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NISBETT",
        "first_name": "KENISHA",
        "middle_name": "AKEILA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-13",
        "last_updated": "2024-05-20",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A17194",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "CA",
            "license": "17194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nirlok Corporation
• Nasiem Marriam Niroumand, M.D.
• Sam Niruyi, DDS
• Shauna Gabriella Nisani
• Kenneth Nisbet, MD
• Robert P. Nisenbaum, M.D.
• Alex Nishi
• Dawnell Nishijima, ATC
• Melanie Nishijo, PHARMD
• Camille Thuy Nishikawa, D.D.S.

• Addiction Medicine (Preventive Medicine) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Addiction Medicine (Preventive Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; 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.