Healthcare Provider Details

I. General information

NPI: 1255347837
Provider Name (Legal Business Name): MARTHA JANE FAULKNER PHD, PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLUE MESA PSYCHIATRY AND COUNSELING, LLC 7007 WYOMING BLVD. NE, SUITE F
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

1112 GIRARD BLVD NE
ALBUQUERQUE NM
87106-2016
US

V. Phone/Fax

Practice location:
  • Phone: 505-807-3086
  • Fax:
Mailing address:
  • Phone: 505-435-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP00569
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00569
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: