Healthcare Provider Details

I. General information

NPI: 1205188331
Provider Name (Legal Business Name): KELLEY BAER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E LOHMAN AVE STE 110-146
LAS CRUCES NM
88001-3167
US

IV. Provider business mailing address

2001 E LOHMAN AVE STE 110-146
LAS CRUCES NM
88001-3167
US

V. Phone/Fax

Practice location:
  • Phone: 505-695-6518
  • Fax:
Mailing address:
  • Phone: 505-695-6518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number19915357
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: