Nicole Mackenzie Bennett, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

200950088NP Issued in OR

Practice address

700 NE Multnomah St
Suite 275
Portland, OR 97232-2131

Phone

(503) 729-1380

Fax

(503) 841-6343

NPI assigned

Aug 10, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Willamette Health & Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
  • NPI 1093140188
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1249862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1164654166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NE MULTNOMAH ST",
            "address_2": "SUITE 275",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322131",
            "telephone_number": "503-729-1380",
            "fax_number": "503-841-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE MULTNOMAH ST",
            "address_2": "SUITE 275",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322131",
            "telephone_number": "503-729-1380",
            "fax_number": "503-841-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "NICOLE",
        "middle_name": "MACKENZIE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-10",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "200950088NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Eloise Bennett
• Kundalini Rose Bennett, LMT
• Laura Sheffield Bennett, PH.D.
• Matthew Scott Bennett, PHARMD
• Miles S Bennett, CPO
• Peter Bennett, LCSW
• Rachel Johanna Bennett, M.D.
• Sarah Marie Bennett, RN
• Sean S Bennett, D.O
• Sheila Bennett, DMD

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.