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SAMANTHA KELLY FNP-C
NPI 1518488634
Nurse Practitioner - Family in Pueblo, CO

Active since June 28, 2017PECOS Enrolled
4036 RIDGE DR, PUEBLO, CO 81008(719) 251-1594(514) 236-8737 Get Directions Write a Review

NPPES record last updated: April 21, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Apr 21, 2026, Jul 29, 2021, Aug 7, 2017 and 1 more (4 updates tracked since 2017).

About Samantha Kelly Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMANTHA KELLY FNP-C (NPI 1518488634) is an individual family provider in Pueblo, Colorado, licensed in Colorado (APN.0995461-NP) and active in the NPI registry since June 2017. She is enrolled in Medicare PECOS and maintains a secondary practice location in Peoria.

NPPES Registry Identity

NPI1518488634
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameSAMANTHA KELLYCredential: FNP-C
Location Address4036 RIDGE DRPueblo, CO 81008-1720
Mailing Address4036 Ridge DrPueblo, CO 81008-1720 · (719) 251-1594 · Fax (514) 236-8737
Phone(719) 251-1594
Fax(514) 236-8737
Sole ProprietorYes
Enumeration DateJune 28, 2017
Last NPPES UpdateApril 21, 20264 updates tracked since enumeration
NPPES CertifiedApril 21, 2026
✔ NPI 1518488634 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in CO · APN.0995461-NP✔ Licensed in AZ · 337690✔ Licensed in CA · 95006818
Also ListedRegistered NurseTaxonomy 163W00000X · License 95034970 (CA)
4036 RIDGE DR, Pueblo, CO 81008
Open in Google Maps ↗

Secondary Practice Location 1

Location 16960 W Peoria Ave Lot 5Peoria, AZ 85345-6025 · Phone (719) 415-0297 · Fax (514) 236-8737

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha Kelly Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 81008 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$89.43 typical visit price
range $58.06 – $174.82
Typical copayment $22.35 (range $14.51 – $43.70)
Most-billed visit code 99203
Established Patient
$102.03 typical visit price
range $18.88 – $142.79
Typical copayment $25.50 (range $4.72 – $35.69)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SIMPLIFIED TELEHEALTH LLC
Clinic/Center (Primary Care)
4036 RIDGE DR
PUEBLO, CO 81008
Pueblo County (719) 251-1594

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samantha Kelly's NPI number?

The NPI number for Samantha Kelly is 1518488634. It was assigned to this individual provider in the NPPES registry on June 28, 2017.

Where is Samantha Kelly located?

Samantha Kelly practices at 4036 Ridge Dr, Pueblo, CO 81008. The listed phone number is (719) 251-1594.

What is Samantha Kelly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Samantha Kelly enrolled in Medicare?

Yes. Samantha Kelly is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samantha Kelly was last updated on April 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.