KIMBERLY GWEN METTETAL (C.F.N.P. CPMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1194911453
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,366 NURSE PRACTITIONER in OR
Provider Addresses for KIMBERLY GWEN METTETAL (C.F.N.P. CPMHNP)
1015 NW 22nd Ave
Portland, OR 972103025
Phone: (503) 413-7711
Type: Location
2211 NE 139th St
Vancouver, WA 986862742
Phone: (360) 487-1000
Type: Location
2505 Mission Dr
Jefferson City, MO 651099508
Phone: (573) 681-3000
Type: Location
386 GWEN RD
SENATOBIA, MS 386686885
Phone: (662) 560-3101
Type: Mailing
309 W MAIN ST
SENATOBIA, MS 386682146
Phone: (662) 560-3101
Type: Mailing
South Medford Drive, Lufkin, Angelina County, Texas, 75901, United States
LUFKIN, TX 759016260
Phone: (936) 639-1141
Fax: (936) 634-8601
Type: Location
2001 S Medford Dr
Lufkin, TX 759016260
Phone: (936) 639-1141
Fax: (936) 634-8601
Type: Location
4050 Coon Rapids Blvd NW
Coon Rapids, MN 554332522
Phone: (763) 236-6000
Type: Location
1629 E Division St
River Falls, WI 540221571
Phone: (715) 307-6000
Type: Location
311 E Main St
Senatobia, MS 386682215
Phone: (662) 772-5937
Fax: (662) 772-5940
Type: Location
700 S Park St
Madison, WI 537151830
Phone: (608) 251-6100
Type: Location
8626 AIRWAYS BLVD
SOUTHAVEN, MS 386712603
Phone: (662) 772-5937
Fax: (662) 772-5940
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $17.
Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.
Last reported payment date: 2023-06-05 • Largest payer in this snapshot: Janssen Pharmaceuticals, Inc ($17).
Total Amount
$17
General + Research + Ownership
Payments
1
Total payment records
General Amount
$17
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-06-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Janssen Pharmaceuticals, Inc | $17 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-03-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040712001008 | I | Nurse Practitioner | MS | TBD |
| I20180328002127 | I | Nurse Practitioner | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 58 | 35 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 22 | 22 | $0 |
Insurance plans in this area (ZIP 97210)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WI | |
| Psychiatry, Neurology | TX | |
| Clinical Social Worker | TX | |
| Mental Health Counselor | TX | |
| - | TX | |
| Mental Health Counselor | TX | |
| Nurse Practitioner | TX | |
| P S Y C H I A T R Y | TX | |
| Mental Health Counselor | TX | |
| Nurse Practitioner | TX |
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