NPI age
19 years
Enumerated 2007-02-05
● Active
Type 1 · Individual
Mary Polleys McCulloch, NNP
McCulloch is 1 of 7 nurse practitioner providers in Boise and 1 of 8 in Idaho.
Primary specialty
Nurse Practitioner
Plus 2 subspecialties
Licensed in
ID, AZ, UT
3 states
Status
Active
No deactivations on record
Last NPPES update
2026-04-27
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 8 active nurse practitioner providers in Idaho.
NPI age
19 years
↑ 9 yr above median (9 yr)
State licenses
3 states
Top 62% — 37% of peers are multi-state
Subspecialties
0
50% of peers hold subspecialties
NPI lifetime · 2007 → 2026
2007-02Enumerated in NPPES
2007
2026
Where they practice
Practice location
190 E Bannock St
Boise, ID 837126241
Mailing address
190 E Bannock St
Boise, ID 837126241
Additional practice locations
2 secondary locations on file with NPPES.
Location 2
50 N Medical Dr
Slc, UT 841320001
Location 3
14502 W Meeker Blvd
Sun City West, AZ 853755282
Specialties
-
Nurse Practitioner PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (AZ) | 176667 |
Multi-state credentialing: Licensed in 3 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 671 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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