Nellie Idara Samuel, MSN, APRN,PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN225022 Issued in GA

Practice address

2400 Northside Xing
Macon, GA 31210-2252

Phone

(865) 765-8225

NPI assigned

Jul 31, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1023174455
  NPD
• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1609939214
  NPD
• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Gilbert, AZ
  • NPI 1881680254
  NPD
• Tucson Counseling PLLC

  • Community/Behavioral Health Agency
  • Tucson, AZ
  • NPI 1740529460
  NPD
• Saint Lazarus Behavioral Health Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Macon, GA
  • NPI 1780814574
  NPD (past)
• Horizon Health and Wellness, Inc.

  • Professional Counselor
  • Globe, AZ
  • NPI 1205931987

  Psychiatric/Mental Health

  NPD (past)
• Horizon Health and Wellness, Inc.

  • Federally Qualified Health Center (FQHC)
  • Oracle, AZ
  • NPI 1710366737
  NPD (past)
• Lags Spine and Sportscare Medical Centers Inc

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Santa Maria, CA
  • NPI 1447244256
  NPD (past)
• Regenerative Spine, Pain, and Neuropathy Centers, Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Bakersfield, CA
  • NPI 1497323570
  NPD (past)

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1821344557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 POST DRIVE",
            "address_2": "P O BOX 6250",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "93912",
            "telephone_number": "865-765-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 NORTHSIDE XING",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102252",
            "telephone_number": "865-765-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "NELLIE",
        "middle_name": "IDARA",
        "credential": "MSN, APRN,PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-31",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "GA",
            "license": "RN225022",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN225022",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "GA",
            "license": "RN225022",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP10318",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95014791",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN225022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sam'S Club Optical
• Sample Sent Solutions LLC
• Sams East Inc
• Joann Sams Sinclair, CFNP
• Latoia Samson, PA
• Amy Marie Samuels, OTR/L, C/NDT
• Martha Lorena Sanchez, DMD
• Reyes Sanchez
• Angelique Sanders, MED, CCC-SLP
• Beverly Barksdale Sanders III, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Macon, GA
• Providers in Macon, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.