Kimberly Ann Mellick, MSN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1137 Issued in WY

Practice address

1110 Maple Way
Jackson, WY 83001

Phone

(307) 733-7003

Fax

(307) 734-8477

NPI assigned

Oct 10, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WY

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

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Whole Family Health IncGroup PAC ID 0143202085, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Johns Medical Center Hospital, Jackson, WY, CCN 530015

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

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.

• Jackson Whole Family Health, Inc.

  • Family Nurse Practitioner
  • Jackson, WY
  • NPI 1053519918
  Medicare reassignment Care Compare group
• Cowboy Kids Pediatrics

  • Pediatrics Physician
  • Wilson, WY
  • NPI 1932348414
  NPD (past)
• Family First Health PC

  • Family Nurse Practitioner
  • Jackson, WY
  • NPI 1093002412
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Teton County Hospital District

  dba St John's Medical Center/ or St John's Health

  • General Acute Care Hospital
  • Jackson, WY
  • NPI 1801835475
  Care Compare affiliation

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

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1073897930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10738",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830020738",
            "telephone_number": "307-733-7003",
            "fax_number": "307-734-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 MAPLE WAY",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "307-733-7003",
            "fax_number": "307-734-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLICK",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MSN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-10",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WY",
            "license": "1137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121882400",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgina H McNiff, RN
• Medical Psychotherapy PC
• Kevin J Meehan, LA.C, NCCAOM, NCCA
• Hannah Meier, DNP
• Babette Epple Melka, PHARMD
• Camille Stephanie Mellijor-Figg, M.D.
• Mental Health & Recovery Services of Jackson Hole
• Mental Health & Recovery Services of Jackson Hole (Curran-Seeley Foundation)
• Carol Ann Mersereau, DIPL. AC.
• Therese Lowe Metherell, RD

• Family Nurse Practitioner in Jackson, WY
• Providers in Jackson, WY by specialty
• Family Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.