NPIMap

Individual provider Active NPI

Faith Marlo McNulty, PMHNP-BC, MSN

  • Psychiatric/Mental Health Nurse Practitioner
  • Longmont, CO
National Provider Identifier
1508629742
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APN.0999663-NP Issued in CO
Practice address
112 Grant St
Longmont, CO 80501-5825
Phone
(970) 978-1700
NPI assigned
Jan 31, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APN.0999663-NP CO Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RXN.0108723-NP CO

Addresses

Primary practice location

112 Grant St
Longmont, CO 80501-5825

Mailing address

112 Grant St
Longmont, CO 80501-5825
Phone (970) 978-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240709004897 CO Practitioner - Nurse Practitioner 6800330788 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Amavi Integrative Mental Wellness LLCGroup PAC ID 4082043401, 27 clinicians

Practice addresses (Care Compare)

2120 Milestone Dr
Suite 103
Fort Collins, CO 80525-5761
Phone (970) 829-8780

6897 Paiute Ave
Suite 5
Niwot, CO 80503-7169
Phone (303) 652-4196

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN.0999663-NPCOMDPsychiatric/Mental Health Nurse Practitioner
RXN.0108723-NPCOMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Amavi Integrative Mental Wellness LLC Psychiatric/Mental Health CurrentSince Jun 10, 2024 Accepting new patients

Locations

6897 Paiute Ave
Ste 5
Niwot, CO 80503
Phone (303) 652-4196

Organizations & group practices 2

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.

Hospital & facility affiliations 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1508629742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 GRANT ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015825",
            "telephone_number": "970-978-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 GRANT ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015825",
            "telephone_number": "970-978-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNULTY",
        "first_name": "FAITH",
        "middle_name": "MARLO",
        "credential": "PMHNP-BC, MSN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-31",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "APN.0999663-NP",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "RXN.0108723-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.