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General NPI Number Information
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NPI Number | 1255965166
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Entity Type | Individual
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Provider Name | KELLY C YAN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/29/2020
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1020 SW TAYLOR ST. SUITE 448
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City | PORTLAND
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State | OR
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Zip | 97205-2509
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Country | US
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Telephone | 971-300-4254
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Fax | 503-200-1241
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Provider Business Mailing Address
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Address Line | 1020 SW TAYLOR ST. SUITE 448
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City | PORTLAND
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State | OR
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Zip | 97205-2509
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Country | US
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Telephone | 971-300-4254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202006258NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201809234RN
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License Number State | OR
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