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General NPI Number Information
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NPI Number | 1053650010
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Entity Type | Individual
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Provider Name | KELLIE ANN NORTHAM PMHNP-BC, CNM
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Gender | Female
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 116 18TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-4841
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Country | US
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Telephone | 208-639-2700
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Fax | 208-639-2736
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Provider Business Mailing Address
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Address Line | 116 18TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-4841
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Country | US
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Telephone | 208-639-2700
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Fax | 208-639-2736
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 61450
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | CNM81-A
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License Number State | ID
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