Healthcare Provider Details

I. General information

NPI: 1689308884
Provider Name (Legal Business Name): BETH MARTIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S ROUTT ST STE 250
LAKEWOOD CO
80228-2271
US

IV. Provider business mailing address

3300 N TRIUMPH BLVD STE 500
LEHI UT
84043-6475
US

V. Phone/Fax

Practice location:
  • Phone: 720-712-0306
  • Fax: 720-654-2702
Mailing address:
  • Phone: 844-692-4100
  • Fax: 801-901-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0997745-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: