MEDICARE: NICHOLE SLYKHOUS MSN, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	201706246NP-PP	OR
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	201507599RN	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1811354871	OTHER	OR	NPI

General Provider Information

NPI Number	:	1811354871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE SLYKHOUS MSN, PMHNP

Provider Business Mailing Address
First Line	:	1720 NW LOVEJOY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2346
Country	:	US
Telephone Number	:	503-922-6633
Fax Number	:	833-551-4824

Provider Business Practice Location Address
First Line	:	1720 NW LOVEJOY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2346
Country	:	US
Telephone Number	:	503-922-6633
Fax Number	:	833-551-4824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	02/04/2026

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