Samantha Nicole Kelly, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

684587 Issued in CA

Practice address

1664 Broadway
El Cajon, CA 92021-5201

Phone

(619) 579-8685

NPI assigned

Apr 6, 2020

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

Other names 1

• Samantha Nicole Balona Former name

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": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1639708191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27129 OAKMONT RD",
            "city": "VALLEY CENTER",
            "state": "CA",
            "postal_code": "920827730",
            "telephone_number": "760-474-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1664 BROADWAY",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920215201",
            "telephone_number": "619-579-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SAMANTHA",
        "middle_name": "NICOLE",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "684587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "BALONA",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elena Dalia Keller
• Marie Keller, AMFT
• Charrion Kellough
• Beth Kelly, MOTR/L
• Kayla Elizabeth Kelly
• Cynthia Kenaston
• Cynia Kendrick
• Sarah Kennedy, OTR/L
• Melissa S Kent, PA-C
• Samantha Kerber

• Licensed Vocational Nurse in El Cajon, CA
• Providers in El Cajon, 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 Apr 6, 2020; 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.