Individual provider Active NPI

Kacy L Herbst, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1053106039
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
10043172 Issued in OR
Practice address
1410 NE 106TH Ave
Portland, OR 97220-3934
Phone
(503) 460-0405
Fax
(503) 460-0434
NPI assigned
Apr 11, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 10043172 OR Primary

Addresses

Primary practice location

1410 NE 106TH Ave
Portland, OR 97220-3934

Mailing address

1410 NE 106TH Ave
Portland, OR 97220-3934
Phone (503) 460-0405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250501003236 OR Practitioner - Nurse Practitioner 0648796664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bridge City Family Medical Clinic PCGroup PAC ID 7810988292, 7 clinicians

Practice addresses (Care Compare)

1410 NE 106TH Ave
Portland, OR 97220-3934
Phone (503) 460-0405

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bridge City Family Medical Clinic, PC CurrentSince May 12, 2025 Accepting new patients

Locations

1410 NE 106th Ave
Portland, OR 97220
Phone (503) 460-0405

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1053106039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 NE 106TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203934",
            "telephone_number": "503-460-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 NE 106TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203934",
            "telephone_number": "503-460-0405",
            "fax_number": "503-460-0434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERBST",
        "first_name": "KACY",
        "middle_name": "L",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-11",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10043172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.