Individual
KELLIE ANN NORTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, CNM
Contact information
Practice address
116 18TH AVE S, NAMPA, ID 83651-4841
(208) 639-2700
(208) 639-2736
Mailing address
116 18TH AVE S, NAMPA, ID 83651-4841
(208) 639-2700
(208) 639-2736
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
61450
ID
367A00000X
Advanced Practice Midwife
CNM81-A
ID
Other
Enumeration date
02/11/2013
Last updated
12/05/2025
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