Individual ProviderShannie Nicole KelleyRegistered NurseNursing Service ProvidersPractice Address490 N Grape St, Escondido, CA 92025-3079(760) 975-9939(858) 213-5913PECOS EnrollmentBased on the most recent information from CMS, provider Shannie Nicole Kelley does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1417750373Provider TypeIndividualFull NameKelley, Shannie NicoleCredentialRNGenderFemaleSole ProprietorNoEnumeration Date3/28/2025Last Updated3/28/2025Contact InformationPractice LocationPractice Address490 N Grape St, Escondido, CA 92025-3079Phone(760) 975-9939FaxUnlisted FaxMailing LocationMailing Address11251 Rancho Carmel Dr Unit 500512, San Diego, CA 92150-8022Phone(858) 213-5913FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense95404362California