Kellie Ann Northam, PMHNP-BC, CNM

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

61450 Issued in ID

Practice address

116 18TH Ave S
Nampa, ID 83651-4841

Phone

(208) 639-2700

Fax

(208) 639-2736

NPI assigned

Feb 11, 2013

Last updated

Dec 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Momma LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Nampa, ID
  • NPI 1376286732
  NPD Authorized official
• Matushka Olga Michael Maternity Associates, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Nampa, ID
  • NPI 1487140265
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764892800000",
    "number": "1053650010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 18TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514841",
            "telephone_number": "208-639-2700",
            "fax_number": "208-639-2736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 18TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514841",
            "telephone_number": "208-639-2700",
            "fax_number": "208-639-2736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORTHAM",
        "first_name": "KELLIE",
        "middle_name": "ANN",
        "credential": "PMHNP-BC, CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-11",
        "last_updated": "2025-12-05",
        "certification_date": "2025-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "61450",
            "primary": true
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "ID",
            "license": "CNM81-A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candise Lee Nomellini
• Norco, Inc.
• Alex L. North, LCPC
• Emily Northam-Mobley, APRN, PMHNP-BC
• Edward John Northam, PH.D.
• Northland Hearing Centers Inc (All American Hearing)
• Northwest Nazarene University Health Clinic
• Jessica Novello, LMSW
• NS and Associates PLLC
• NS Downtown PLLC

• Psychiatric/Mental Health Nurse Practitioner in Nampa, ID
• Providers in Nampa, ID by specialty
• Psychiatric/Mental Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.