KELLY C YAN PMHNP-BC
NPI 1255965166
Nurse Practitioner - Psychiatric/Mental Health in Portland, OR
NPI Status: Active since February 29, 2020
Contact Information
1020 SW TAYLOR ST. SUITE 448
PORTLAND, OR
ZIP 97205
Phone: (971) 300-4254
Fax: (503) 200-1241
- Individual
- Female
- Nurse Practitioner
- Psychiatric/Mental Health
- Accepts Insurance
- Opted-Out Medicare
About KELLY YAN
This page provides the complete NPI Profile along with additional information for Kelly Yan, a provider established in Portland, Oregon with a medical specialization in Nurse Practitioner, focusing in psychiatric/mental health . The healthcare provider is registered in the NPI registry with number 1255965166 assigned on February 2020. The practitioner's primary taxonomy code is 363LP0808X with license number 202006258NP-PP (OR). The provider is registered as an individual and her NPI record was last updated June 2025.
- NPI
- 1255965166
- Provider Name
- KELLY C YAN PMHNP-BC
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 1020 SW TAYLOR ST. SUITE 448 PORTLAND, OR 97205
- Location Phone
- (971) 300-4254
- Location Fax
- (503) 200-1241
- Mailing Address
- 1020 SW TAYLOR ST. SUITE 448 PORTLAND, OR 97205
- Mailing Phone
- (971) 300-4254
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 02-29-2020
- Last Update Date
- 06-18-2025
- Code Navigator
A nurse practitioner (NP) like Kelly Yan is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Kelly Yan opted out of Medicare effective on 04-01-2023 until 04-01-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner Psychiatric/Mental Health
- Taxonomy Code
- 363LP0808X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 202006258NP-PP
- License State
- OR
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 163W00000X | Nursing Service Providers | Registered Nurse | 201809234RN (OR) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - EPO
- BridgeSpan Standard Gold Plan - EPO
- BridgeSpan Standard Silver Plan - EPO
- Moda Health Affinity Bronze 7750 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Moda Select Bronze 8700 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Bronze HDHP 7500 - EPO
- Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Gold 1800 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Silver 3500 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Silver 4800 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Silver 6400 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Connect 1500 Gold - EPO
- Connect 5000 Silver - EPO
- Connect 9200 Bronze - EPO
- HSA Qualified 7100 Bronze - Signature Network - EPO
- HSA Qualified 7100 Bronze - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
- Providence Oregon Standard Silver Plan - Signature Network - EPO
- Bronze Essential 8500 With 4 Copay No Deductible Office Visits Individual and Family Network - EPO
- Bronze HSA 7000 Individual and Family Network - EPO
- Gold 2300 Individual and Family Network - EPO
- Regence Standard Bronze Plan Individual and Family Network - EPO
- Regence Standard Gold Plan Individual and Family Network - EPO
- Regence Standard Silver Plan Individual and Family Network - EPO
- Silver 6200 Individual and Family Network - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 04-01-2023
Opt-Out End Date: 04-01-2027
Eligible to Order and Refer? No
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 5 | 5 | 9 | 6 | 5 | 1 | 6 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 10 | 5 | 18 | 6 | 10 | 1 | 12 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 1 + 0 + 5 + 1 + 8 + 6 + 1 + 0 + 1 + 1 + 2 + 24 = 54 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 54 = 6 | 6 | ||||||||
The NPI number 1255965166 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1255965166, enumerated in the NPI registry as an "individual" on February 29, 2020
The provider is located at 1020 Sw Taylor St. Suite 448 Portland, Or 97205 and the phone number is (971) 300-4254
The provider's speciality is Nurse Practitioner with taxonomy code 363LP0808X with a focus in Psychiatric/Mental Health
The provider might be accepting Accepts: BridgeSpan Health Company, Moda Health Plan, Inc.,. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
No, the provider signed an affidavit on April 01, 2023 to opt-out of the Medicare program. The provider is excluded from the Medicare program until April 01, 2027.
This NPI record was last updated on February 29, 2020. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.