Momma LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MOMMA LLC

Practice address

116 18TH Ave S
Nampa, ID 83651-4841

Phone

(208) 807-2867

Fax

(208) 639-2736

NPI assigned

Apr 14, 2022

Organization subpart

No

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

Authorized official

Name

Kellie Northam, PMHNP,BCNPI 1053650010

Title

Primary Operator

Phone

(712) 828-0234

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kellie Ann Northam, PMHNP-BC, CNM

  • Psychiatric/Mental Health Nurse Practitioner
  • Nampa, ID
  • NPI 1053650010
  NPD Authorized official

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1376286732",
    "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": "208-807-2867",
            "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": "208-807-2867",
            "fax_number": "208-639-2736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-14",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "NORTHAM",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "PRIMARY OPERATOR",
        "authorized_official_telephone_number": "712-828-0234",
        "authorized_official_credential": "PMHNP,BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "knorthampmhnp.bc@gmail.com",
            "affiliation": "N",
            "endpointDescription": "private email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "116 18th Ave S",
            "city": "Nampa",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836514841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• 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 Apr 14, 2022; 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.