Nelly Merveille Nzokou Nkenfack

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1234 Issued in OR

Practice address

2730 S Moody Ave
Portland, OR 97201-5042

Phone

(971) 570-4676

NPI assigned

Sep 19, 2022

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

Other names 1

• Nelly Merveille Nouboussi Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1801519509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 S MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 S MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042",
            "telephone_number": "971-570-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NZOKOU NKENFACK",
        "first_name": "NELLY",
        "middle_name": "MERVEILLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-19",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "1234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NELLY",
            "last_name": "NOUBOUSSI",
            "middle_name": "MERVEILLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Kaye Nystrom, CHN
• Lisa Marie Nystrom, LPN
• Yarley Nystrom, L.M.T.
• Taylor Nyulassy
• Steve Nzele
• Myong Penny O, CSWA
• Katy O'Bannon
• Katherine Eileen O'Bar, RD
• Megan O'Bara
• Kit B O'Boyle, RN, BSN, MSW, LCSW

• Internal Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.