Individual provider Active NPI

Jennifer L Holland, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1073533451
Registry record updated Sep 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
10021159 Issued in OR
Practice address
10373 NE Hancock St Ste 200
Portland, OR 97220-3873
Phone
(503) 253-6754
NPI assigned
Jul 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 7866 OR
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 10021159 OR Primary

Addresses

Primary practice location

10373 NE Hancock St Ste 200
Portland, OR 97220-3873

Mailing address

PO Box 8459
Portland, OR 97207-8459

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
I20240925000778 OR Practitioner - Nurse Practitioner 9830630250 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cascadia HealthGroup PAC ID 7618873761, 53 clinicians
Moonshot Psychiatric Nurse Practitioner PCGroup PAC ID 9335589696, 79 clinicians

Practice addresses (Care Compare)

10373 NE Hancock St
Suite 200
Portland, OR 97220-3873
Phone (503) 253-6754

3456 SE Harold CT
Portland, OR 97202-4342
Phone (201) 748-2806

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7866ORMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
10021159ORMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cascadia Health Current Accepting new patients
Sokyahealth Medical Group PC Psychiatric/Mental Health CurrentSince Feb 1, 2025 Accepting new patients
Cascadia Health CurrentSince Sep 9, 2024 Accepting new patients
Headlight Health Medical Group PLLC CurrentSince Feb 25, 2026 Accepting new patients
Moonshot Psychiatric Nurse Practitioner PC Psychiatric/Mental Health CurrentSince Aug 22, 2025 Accepting new patients

Locations

4800 S Macadam Ave
Ste 230
Portland, OR 97239
Phone (866) 657-6592

707 NW Everett St
Portland, OR 97209
Phone (503) 222-4906

700 NE Multnomah St
Ste 870
Portland, OR 97232
Phone (503) 238-5559

10373 NE Hancock St
Ste 200
Portland, OR 97220
Phone (503) 253-6754

Interoperability endpoints

  • Direct secure messaging: jholland736261@direct.ochin.org
  • Direct secure messaging: jennifer.holland.p1@direct.sokya.nextgenshare.com

Organizations & group practices 5

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725667200000",
    "number": "1073533451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10373 NE HANCOCK ST STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203873",
            "telephone_number": "503-253-6754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Miss",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-09-07",
        "certification_date": "2024-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "7866",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10021159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.