Powered by Self Love Oregon LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

POWERED BY SELF LOVE OREGON LLC

Doing business as

Powered By Self Love Oregon LLC

Practice address

5305 River Rd N Ste B1
Keizer, OR 97303-5324

Phone

(657) 321-9765

Fax

(229) 218-2667

NPI assigned

Apr 13, 2022

Last updated

Nov 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Loan Pham, DOCTOR OF NURSE PRACNPI 1053440065

Title

Founder, Ceo

Phone

(714) 880-5065

Specialties & licenses 1

Addresses

Other names 1

• Powered By Self Love Oregon LLC Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Loan Vu Minh Pham, DNP

  • Family Nurse Practitioner
  • Fife, WA
  • NPI 1053440065

  Multi-Specialty

  Medicare reassignment NPD Authorized official
• Nari Kim

  • Psychiatric/Mental Health Nurse Practitioner
  • Garden Grove, CA
  • NPI 1528751161
  NPD (past)

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1821730417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16027 BROOKHURST ST STE I-732",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927081551",
            "telephone_number": "657-321-9765",
            "fax_number": "229-218-2667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5305 RIVER RD N STE B1",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973035324",
            "telephone_number": "657-321-9765",
            "fax_number": "229-218-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWERED BY SELF LOVE OREGON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "LOAN",
        "authorized_official_title_or_position": "FOUNDER, CEO",
        "authorized_official_telephone_number": "714-880-5065",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DOCTOR OF NURSE PRAC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@poweredbyself-love.com",
            "affiliation": "N",
            "endpointDescription": "info@poweredbyself-love.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5305 River Rd N Ste B1",
            "city": "Keizer",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973035324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Powered By Self Love Oregon LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Keizer, OR
• Providers in Keizer, 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 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.