Provider Demographics
NPI:1255347837
Name:FAULKNER, MARTHA JANE (PHD, PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PHD, PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 GIRARD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2016
Mailing Address - Country:US
Mailing Address - Phone:505-435-4207
Mailing Address - Fax:
Practice Address - Street 1:BLUE MESA PSYCHIATRY AND COUNSELING, LLC
Practice Address - Street 2:7007 WYOMING BLVD. NE, SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-807-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00569363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner