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General NPI Number Information
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NPI Number | 1124895958
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Entity Type | Individual
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Provider Name | KEARIESHA NATALEE ADDISON SAMUELS
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Gender | Female
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 77 CADILLAC DR STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95825-8337
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Country | US
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Telephone | 916-569-8484
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Fax | 916-457-2667
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Provider Business Mailing Address
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Address Line | 3375 SW 173RD WAY
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City | MIRAMAR
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State | FL
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Zip | 33029-2605
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Country | US
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Telephone | 786-267-4646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11030106
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95029249
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License Number State | CA
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