Kimberly Gwen Mettetal, C.F.N.P. CPMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R850409 Issued in MS

Practice address

8626 Airways Blvd
Southaven, MS 38671-2603

Phone

(662) 772-5937

Fax

(662) 772-5940

NPI assigned

Sep 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 8

Addresses

Other identifiers 2

Other names 1

• Kimberly G Mettetal Other name

Medicare fee-for-service enrollment

Enrolled in MS, TX2 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 2

Specialty

Nurse Practitioner

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Gulf Coast CenterGroup PAC ID 6204821895, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• The Gulf Coast Center

  • Psychiatry Physician
  • League City, TX
  • NPI 1245285899
  Medicare reassignment Care Compare group NPD
• Desoto Family Counseling Center PLLC

  • Community/Behavioral Health Agency
  • Southaven, MS
  • NPI 1912214792
  Medicare reassignment NPD
• Burke Center

  • Psychiatry Physician
  • Lufkin, TX
  • NPI 1396792420
  Medicare reassignment NPD
• Texana Center

  • Multi-Specialty Clinic/Center
  • Rosenberg, TX
  • NPI 1912954058
  NPD
• Burke Center

  • Developmental Disabilities Clinic/Center
  • Lufkin, TX
  • NPI 1164572772
  NPD (past)
• Forefront Telecare Inc

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1174035612
  NPD (past)

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1194911453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940"
        }
    ],
    "practiceLocations": [
        {
            "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"
        },
        {
            "address_1": "311 E Main St",
            "address_purpose": "LOCATION",
            "city": "Senatobia",
            "state": "MS",
            "postal_code": "386682215",
            "country_code": "US",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "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": "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": "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": "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": "2001 S Medford Dr",
            "address_purpose": "LOCATION",
            "city": "Lufkin",
            "state": "TX",
            "postal_code": "759016260",
            "country_code": "US",
            "telephone_number": "936-639-1141",
            "fax_number": "936-634-8601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "METTETAL",
        "first_name": "KIMBERLY",
        "middle_name": "GWEN",
        "credential": "C.F.N.P. CPMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-20",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R850409",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2018026553",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60842248",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "8391-33",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "2018",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "5816",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP136974",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "R850409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06787540",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382605901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "METTETAL",
            "middle_name": "G",
            "credential": "PMHNP-BC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Memphis Children's Clinic, PLLC
• Memphis Hand Center (Southern Hand Centers)
• Austin Mengarelli
• Madalyn G Messick, PLPC
• Cathy G Meteer, LPC
• Alexander Meyer, MD
• Timothy J Micek, M.D.
• Michael E Foster MD PC
• Michael E Steuer MD PC
• Micheal G Cook OD PC (eyear optical)

• Psychiatric/Mental Health Nurse Practitioner in Southaven, MS
• Providers in Southaven, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.