Provider Demographics
NPI:1356688618
Name:CONNELLY, JANET L (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 CORBETT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9579
Mailing Address - Country:US
Mailing Address - Phone:970-207-4800
Mailing Address - Fax:970-207-4885
Practice Address - Street 1:4601 CORBETT DR.
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-4000
Practice Address - Country:US
Practice Address - Phone:970-207-4800
Practice Address - Fax:970-207-4885
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0126662363LP0808X
COAPN.0990701-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01244774OtherRR MEDICARE
WYW25216Medicaid
CO80155031Medicaid
CO314863YT5XMedicare PIN