Carly Ellison, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

C-APN.0003842-C-NP Issued in CO

Practice address

7900 E Union Ave Ste 1100
Denver, CO 80237-2746

Phone

(303) 414-1164

Fax

(813) 906-7789

NPI assigned

May 29, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Revitalize Psychiatric Services IncGroup PAC ID 9830552546, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Revitalize Psychiatric Services, Inc.

  dba Revitalize Psychiatric Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Denver, CO
  • NPI 1174212047
  Medicare reassignment Care Compare group NPD
• HSHS Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Jacksonville, IL
  • NPI 1629465414
  NPD (past)

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

{
    "created_epoch": "1432857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1508245028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047437",
            "telephone_number": "217-698-9722",
            "fax_number": "217-391-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 E UNION AVE STE 1100",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802372746",
            "telephone_number": "303-414-1164",
            "fax_number": "813-906-7789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 Old Jacksonville Rd",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627047437",
            "country_code": "US",
            "telephone_number": "217-698-9722",
            "fax_number": "217-391-0392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "CARLY",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-29",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209012884",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209012884",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "C-APN.0003842-C-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melodie Ellis
• Nita G Ellis, M.D.
• Samuel Lee Ellis, PHARM.D., CDE, BCPS
• Tierra Lashay Ellis, DO
• Toya A Ellis, MD
• Claire Ellison, PT,DPT
• Genell Ellison, MBA, MAHS
• Kimberly Paige Ellison, LCSW
• Maureen Ellison, LCSW
• Barbara Ellman, LCSW

• Psychiatric/Mental Health Nurse Practitioner in Denver, CO
• Providers in Denver, CO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.