Kellie Ann Northam, CNM is a
Advanced Practice Midwife based in Eagle, Idaho. Kellie Ann Northam is licensed to practice in Idaho (license number CNM81-A) and her current practice location is
192 West State Street, Eagle, Idaho. She can be reached at her office (for appointments etc.) via phone at
(208) 807-2867.
NPI number for Kellie Ann Northam is 1053650010 and her current mailing address is 919 13th Ave S, Nampa, Idaho. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1053650010.
Provider's Profile
| Full Name | Kellie Ann Northam |
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| Gender | Female |
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| Speciality | Advanced Practice Midwife |
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| Location | 192 West State Street, Eagle, Idaho |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1053650010
- Provider Enumeration Date: 02/11/2013
- Last Update Date: 05/20/2019
Medical Identifiers
Medical identifiers for Kellie Ann Northam such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1053650010 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 367A00000X | Advanced Practice Midwife | CNM81-A (Idaho) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | CNP (Idaho) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kellie Ann Northam is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kellie Ann Northam, CNM
919 13th Ave S,
Nampa, ID 83651-4618
Ph: (712) 828-0234 | Kellie Ann Northam, CNM
192 West State Street,
Eagle, ID 83616
Ph: (208) 807-2867 |
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