Individual provider Active NPI

Janiece Desocio, PHD, RN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1083790554
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Practice address
2800 N Vancouver Ave
Suite 118
Portland, OR 97227-1630
Phone
(503) 249-8851
Fax
(503) 282-3409
NPI assigned
Oct 27, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X OR
Psychiatric/Mental Health Nurse Practitioner 363LP0808X OR Primary

Addresses

Primary practice location

2800 N Vancouver Ave
Suite 118
Portland, OR 97227-1630

Mailing address

2581 NE 31St Ave
Portland, OR 97212-3660
Phone (503) 235-0545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy, Registered Nurse

State licenses

LicenseStateTypeSpecialty
200242151 RNORMDRegistered Nurse
200250110NPORMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kartini Clinic PC Psychiatric/Mental Health PastSince Jul 24, 2022 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1083790554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2581 NE 31ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123660",
            "telephone_number": "503-235-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 N VANCOUVER AVE",
            "address_2": "SUITE 118",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271630",
            "telephone_number": "503-249-8851",
            "fax_number": "503-282-3409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESOCIO",
        "first_name": "JANIECE",
        "name_prefix": "Dr.",
        "credential": "PHD, RN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.