Provider Demographics
NPI:1972397610
Name:KLOKKHAMMER, ELYSSA MARIE (CNM)
Entity type:Individual
Prefix:MRS
First Name:ELYSSA
Middle Name:MARIE
Last Name:KLOKKHAMMER
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:ELYSSA
Other - Middle Name:MARIE
Other - Last Name:FIELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75-5851 KUAKINI HWY # 461
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2199
Mailing Address - Country:US
Mailing Address - Phone:248-798-4840
Mailing Address - Fax:
Practice Address - Street 1:75-5851 KUAKINI HWY # 461
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2199
Practice Address - Country:US
Practice Address - Phone:248-798-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-5001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife