Provider Demographics
NPI:1366924193
Name:MACADAM, KELLI LYN (CNM)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:LYN
Last Name:MACADAM
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12200 WARWICK BLVD STE 510
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2548
Practice Address - Country:US
Practice Address - Phone:757-534-5700
Practice Address - Fax:757-534-5730
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2023-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001231620176B00000X
VA0024176652367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife