MR. ETIENNE CLEMENT POUFONG (NP) – Psychiatry Physician, NPI 1023626959
Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,261 NURSE PRACTITIONER in WA
Provider Addresses for MR. ETIENNE CLEMENT POUFONG (NP)
1001 - MOUNTLAKE TERRACE
MOUNTLAKE TERRACE, WA 980437510
Phone: (469) 321-9543
Type: Location
700 Milam St Ste 1300
Houston, TX 770022736
Phone: (469) 321-9543
Type: Location
2800 E Broad St Ste 400
Mansfield, TX 760636414
Phone: (469) 321-9543
Fax: (682) 227-2030
Type: Location
708 Clement dr
Cedar Hill, TX 751047510
Phone: (469) 321-9543
Fax: (682) 227-2030
Type: Location
708 CLEMENT DR
CEDAR HILL, TX 751047352
Phone: (469) 321-9543
Fax: (817) 471-3269
Type: Mailing
2233 AVENUE J STE 101
ARLINGTON, TX 760065884
Phone: (469) 321-9543
Fax: (817) 471-3269
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 41 Open Payments records for all available years, with a total value of $1,766.
Total Amount is formed as General ($1,766) + Research ($0) + Ownership ($0) = $1,766.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Janssen Pharmaceuticals, Inc ($1,120).
Total Amount
$1,766
General + Research + Ownership
Payments
41
Total payment records
General Amount
$1,766
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2025-01-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 4 Medicare enrollment records; no due dates published yet.
Enrollment records
4
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 |
|---|---|---|---|---|
| I20210614000427 | I | Nurse Practitioner | TX | TBD |
| I20231109001711 | I | Nurse Practitioner | WA | TBD |
| I20240822001313 | I | Nurse Practitioner | DC | TBD |
| I20250116002279 | I | Nurse Practitioner | CO | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 98043)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WA | |
| P S Y C H I A T R Y | TX | |
| Nurse Practitioner | WA | |
| Nurse Practitioner | TX |
Reviews
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