Individual provider Active NPI

Kimberly Ann Cotton, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Mountain View, CA
National Provider Identifier
1194757385
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2018026394 Issued in MO
Practice address
303 Bryant St
Mountain View, CA 94041-1552
Phone
(888) 995-2230
Fax
(650) 242-7520
NPI assigned
Jul 7, 2006
Last updated
Feb 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 8141-33 WI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 201802038NP-PP OR
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0372662-34 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP60835480 WA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 5579 MN
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2018026394 MO Primary

Addresses

Primary practice location

303 Bryant St
Mountain View, CA 94041-1552

Mailing address

5308 Vale St
Greenville, TX 75402-6436
Phone (903) 780-6793

Other practice location 1

1015 NW 22nd Ave
Portland, OR 97210-3025
Phone (503) 413-7711

Other practice location 2

2211 NE 139th St
Vancouver, WA 98686-2742
Phone (360) 487-1000

Other practice location 3

700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100

Other practice location 4

1629 E Division St
River Falls, WI 54022-1571
Phone (715) 307-6000

Other practice location 5

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6000

Other practice location 6

2505 Mission Dr
Jefferson City, MO 65109-9508
Phone (573) 681-3000

Other identifiers 1

IdentifierTypeStateIssuer
1782260MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kcotton396878@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WA, OR, WI4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20050607000381 TX Practitioner - Nurse Practitioner 5193768588 Reassigns benefits to 1 organization
I20180416000101 WA Practitioner - Nurse Practitioner 5193768588 Reassigns benefits to 2 organizations
I20180501000811 OR Practitioner - Nurse Practitioner 5193768588 Reassigns benefits to 2 organizations
I20201109001267 WI Practitioner - Nurse Practitioner 5193768588 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5579MNMDPsychiatric/Mental Health Nurse Practitioner
2018026394MOMDPsychiatric/Mental Health Nurse Practitioner
0372662-34TXMDPsychiatric/Mental Health Nurse Practitioner
AP60835480WAMDPsychiatric/Mental Health Nurse Practitioner
8141-33WIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Border Region MH Mr Community Center CurrentSince Jul 11, 2017 Accepting new patients
Cow Creek Band of Umpqua Tribe of Indians CurrentSince Oct 1, 2022 Accepting new patients
Mindstrong Health Services, PC CurrentSince Mar 4, 2021 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jun 1, 2018 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Mar 1, 2021 Accepting new patients
King County Public Hospital District No 2 CurrentSince Mar 1, 2021 Accepting new patients
Mindstrong Health Services Co PC CurrentSince Nov 21, 2021 Accepting new patients
Allina Health System Current Accepting new patients
White Bird Clinic CurrentSince Oct 30, 2020 Accepting new patients
Allina Health System CurrentSince Jul 29, 2020 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jun 1, 2018 Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients
Legacy Clinics LLC CurrentSince Jun 1, 2018 Accepting new patients
Fernando M. Siles, MD, PLLC PastSince Feb 8, 2013 Accepting new patients
Julia Larsen PLCC, Corporation Psychiatric/Mental Health PastSince Sep 1, 2019 Accepting new patients

Locations

303 Bryant St
Mountain View, CA 94041
Phone (469) 217-4118

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

1400 Mill St
Eugene, OR 97401
Phone (541) 344-8302

341 E 12th Ave
Eugene, OR 97401
Phone (541) 342-8255

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

1015 NW 22nd Ave
#34
Portland, OR 97210
Phone (503) 413-6386

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

12040 NE 128th St
Kirkland, WA 98034
Phone (425) 899-1000

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/whitebirdclinic/r4/
  • Direct secure messaging: kcotton396878@excellian.direct.allina.com
  • Direct secure messaging: kimberly.cotton.p1@direct.whitebirdclinic.nextgenshare.com

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1194757385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5308 VALE ST",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754026436",
            "telephone_number": "903-780-6793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 BRYANT ST",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940411552",
            "telephone_number": "888-995-2230",
            "fax_number": "650-242-7520"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 NW 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972103025",
            "country_code": "US",
            "telephone_number": "503-413-7711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2211 NE 139th St",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986862742",
            "country_code": "US",
            "telephone_number": "360-487-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 S Park St",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537151830",
            "country_code": "US",
            "telephone_number": "608-251-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1629 E Division St",
            "address_purpose": "LOCATION",
            "city": "River Falls",
            "state": "WI",
            "postal_code": "540221571",
            "country_code": "US",
            "telephone_number": "715-307-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4050 Coon Rapids Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554332522",
            "country_code": "US",
            "telephone_number": "763-236-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2505 Mission Dr",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "MO",
            "postal_code": "651099508",
            "country_code": "US",
            "telephone_number": "573-681-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COTTON",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "8141-33",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201802038NP-PP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "0372662-34",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60835480",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "5579",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2018026394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1782260",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcotton396878@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "4050 Coon Rapids Blvd NW",
            "city": "Coon Rapids",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554332522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mountain View, CA

Sources for this page

Verify at the official NPI Registry.