Irena Mattingly, AGNP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

10007639 Issued in OR

Practice address

6214 SE Milwaukie Ave
Portland, OR 97202-5417

Phone

(503) 908-6616

Fax

(225) 351-9980

NPI assigned

May 2, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Irena Gochenour Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 27, 2025 through Jan 27, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1682985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1457040818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6812 SE DREW ST",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972221830",
            "telephone_number": "503-707-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6214 SE MILWAUKIE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025417",
            "telephone_number": "503-908-6616",
            "fax_number": "225-351-9980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "IRENA",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-02",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "10007639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRENA",
            "last_name": "GOCHENOUR",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sharlene Matthieu, M.D.
• John Matti
• Vera Matti
• Elizabeth C Mattia, MA, NCC
• Alexandra Ryan Mattingly, QMHA-R
• Anne E Mattis, RN
• Steven J Mattison, MD
• Tracy Ann Mattner, LMT
• Mikel Matto, M.D.
• Cassidy Mattos, BSW

• Primary Care Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Primary Care Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.