Provider Demographics
NPI:1821503319
Name:KELLAR, NOA CATHERINE (CDM CPM)
Entity Type:Individual
Prefix:
First Name:NOA
Middle Name:CATHERINE
Last Name:KELLAR
Suffix:
Gender:F
Credentials:CDM CPM
Other - Prefix:
Other - First Name:NOA
Other - Middle Name:
Other - Last Name:BELISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4050 LAKE OTIS PARKWAY, SUITE 111
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3268
Mailing Address - Country:US
Mailing Address - Phone:907-444-3027
Mailing Address - Fax:844-621-5905
Practice Address - Street 1:4050 LAKE OTIS PARKWAY, SUITE 111
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3268
Practice Address - Country:US
Practice Address - Phone:907-444-3027
Practice Address - Fax:844-621-5905
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK126457176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1678481Medicaid