Savannah Grace Keller, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

95010542 Issued in CA

Practice address

415 Georgia St
Vallejo, CA 94590-6004

Phone

(707) 556-8100

Fax

(707) 556-8107

NPI assigned

Mar 18, 2019

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

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

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Concord, CA
  • NPI 1538181482
  Medicare reassignment
• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1144336181
  NPD
• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1346262292
  NPD
• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Vallejo, CA
  • NPI 1992863096
  NPD
• La Clinica de la Raza, Inc.

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1427070374
  NPD (past)

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1467911685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22210",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946232210",
            "telephone_number": "510-535-4000",
            "fax_number": "510-535-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 GEORGIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906004",
            "telephone_number": "707-556-8100",
            "fax_number": "707-556-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "SAVANNAH",
        "middle_name": "GRACE",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-18",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95010542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Cecelia Kawecki-Shelly
• Kelvin Nolan Kay, M.D.
• Cynthia Tanner Keane, RN
• Suraj Kedarisetty, MD
• Chandra Nicole Keebler Bloom, MD
• Susan Keller, PH.D
• Brittany Wilkinson Kelley, MSW
• Claire Cepeda Kelley, BA, SOCIAL WORK
• Diane M. Kelley, MD
• Brian Emory Kellogg, LMFT

• Pediatric Nurse Practitioner in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Pediatric Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.