Individual provider Active NPI

Julee Kim, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1912285180
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
201701615NP Issued in OR
Practice address
11740 SW 68TH Pkwy Ste 200
Portland, OR 97223-9058
Phone
(971) 352-6971
NPI assigned
Jul 22, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 201701615NP OR Primary
Mental Health Counselor 101YM0800X 201141413RN OR
Registered Nurse 163W00000X 851920 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95002868 CA

Addresses

Primary practice location

11740 SW 68TH Pkwy Ste 200
Portland, OR 97223-9058

Mailing address

1901 Esther St
Newberg, OR 97132-9529
Phone (503) 554-7925

Other practice location 1

1901 Esther St
Newberg, OR 97132-9529
Phone (503) 554-7925

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230908002923 OR Practitioner - Nurse Practitioner 6901105394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

11740 SW 68TH Pkwy
Suite 200
Tigard, OR 97223-9058
Phone (971) 352-6984

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
201701615NPORMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Therapy Group PC Mental Health CurrentSince Aug 25, 2023 Accepting new patients

Locations

5440 SW Westgate Dr
Ste 350
Portland, OR 97221
Phone (503) 292-1100

11740 SW 68th Pkwy
Ste 200
Tigard, OR 97223
Phone (425) 477-4216

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1912285180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 ESTHER ST",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971329529",
            "telephone_number": "503-554-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 SW 68TH PKWY STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972239058",
            "telephone_number": "971-352-6971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 Esther St",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971329529",
            "country_code": "US",
            "telephone_number": "503-554-7925",
            "fax_number": "503-554-4397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JULEE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-22",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201701615NP",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "201141413RN",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "851920",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95002868",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.