MRS. KIMBERLY ANN MELLICK (MSN, FNP-BC) – Family Nurse Practitioner, NPI 1073897930
Family Nurse Practitioner
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
596 NURSE PRACTITIONER in WY
Provider Addresses for MRS. KIMBERLY ANN MELLICK (MSN, FNP-BC)
PO BOX 428
JACKSON, WY 830010428
Phone: (307) 739-8999
Fax: (307) 739-9222
Type: Mailing
1415 S HWY 89
JACKSON, WY 830018515
Phone: (307) 739-8999
Fax: (307) 739-9222
Type: Location
PO BOX 10738
JACKSON, WY 830020738
Phone: (307) 733-7003
Fax: (307) 734-8477
Type: Mailing
1110 MAPLE WAY
JACKSON, WY 83001
Phone: (307) 733-7003
Fax: (307) 734-8477
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2012-05-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20120508000607 | I | Nurse Practitioner | WY | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 15 | 12 | $0 |
Insurance plans in this area (ZIP 83001)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WY |
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