Kimberly Demattie, APRN-CNP, LSW

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.0026784 Issued in OH

Practice address

205 Marion Pike
Coal Grove, OH 45638-3165

Phone

(740) 532-1188

NPI assigned

Nov 8, 2017

Last updated

Aug 29, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdemattie28472@valleyhealthsystems.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ironton & Lawrence County Area Community Action Organization

  dba Ironton Health Care Campus

  • Federally Qualified Health Center (FQHC)
  • Ironton, OH
  • NPI 1093022287
  Medicare reassignment NPD
• Ironton & Lawrence County Area Community Action Organization

  dba Chesapeake Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Chesapeake, OH
  • NPI 1215014113
  Medicare reassignment NPD
• Ironton & Lawrence County Area Community Action Organization

  dba Aid Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Kitts Hill, OH
  • NPI 1770839276
  Medicare reassignment NPD
• Ironton & Lawrence County Area Community Action Organization

  dba Proctorville Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Proctorville, OH
  • NPI 1912254574
  Medicare reassignment NPD
• Valley Health Systems Inc

  dba Valley Health Coal Grove

  • Federally Qualified Health Center (FQHC)
  • Coal Grove, OH
  • NPI 1629043708
  Medicare reassignment NPD
• Ironton & Lawrence County Area Community Action Organization

  dba Nancy's Place

  • Primary Care Clinic/Center
  • Ironton, OH
  • NPI 1306461694
  NPD
• Ironton & Lawrence County Area Community Action Organization

  dba One Stop Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Ironton, OH
  • NPI 1588151872
  NPD
• Valley Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Huntington, WV
  • NPI 1508720913
  NPD

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1154834539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1680",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257171680",
            "telephone_number": "304-781-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 MARION PIKE",
            "city": "COAL GROVE",
            "state": "OH",
            "postal_code": "456383165",
            "telephone_number": "740-532-1188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Township Road 508 E",
            "address_purpose": "LOCATION",
            "city": "South Point",
            "state": "OH",
            "postal_code": "456807276",
            "country_code": "US",
            "telephone_number": "740-377-2712",
            "fax_number": "740-377-2588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMATTIE",
        "first_name": "KIMBERLY",
        "credential": "APRN-CNP, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-08",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.0028154",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.444863",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0026784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0405888",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100763640",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emillie Crank, PMHNP
• Crystal Care of Ironton, LLC (Crystal Care of Coal Grove)
• Christopher S Davis, LSW
• Dawson Bryant Local Schools
• Erik Ray Delong, PHARM D
• Eric Depriest
• Joseph Derosa, D.O.
• Diagnostics Imaging, LLC
• Eric C Downey
• Randi Drummond

• Psychiatric/Mental Health Nurse Practitioner in Coal Grove, OH
• Providers in Coal Grove, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.