Samantha Kettle, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY29461 Issued in CA

Practice address

1201 Alhambra Blvd Ste 340
Sacramento, CA 95816-5242

Phone

(916) 731-7951

NPI assigned

Jul 29, 2009

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment
• Sutter North Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)
• Sutter West Bay Medical Foundation

  • Family Medicine Physician
  • Santa Rosa, CA
  • NPI 1346575073
  NPD (past)

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1679704472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 ALHAMBRA BLVD STE 340",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165242",
            "telephone_number": "916-731-7951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 ALHAMBRA BLVD STE 340",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165242",
            "telephone_number": "916-731-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLE",
        "first_name": "SAMANTHA",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-29",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Ketchum
• Renee Christine Ketchum
• Saniya Aujaray Ketchum
• Eva Ketron
• Ashley Kettenhofen
• Jasmine Kettley, PA-C
• Jae Whan Keum, MD
• Yo Sup Keum, MD
• Heather Nadia Keven, MA, MFTI
• Kevin & Luz Enterprises Inc

• Clinical Psychologist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; 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.