Kelly Rene Mattimoe, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1085712 Issued in TX

Practice address

612 N Washington Ave Ste 200
Odessa, TX 79761-4436

Phone

(432) 332-9263

Fax

(432) 332-9264

NPI assigned

Aug 12, 2022

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

Medicare fee-for-service enrollment

Enrolled in TX

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

James Y Li MdpaGroup PAC ID 8224063441, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• James Y Li MD PA

  • Vascular Surgery Physician
  • Odessa, TX
  • NPI 1093799025
  Medicare reassignment Care Compare group NPD
• Endovascular Lab PLLC

  • Vascular Surgery Physician
  • Odessa, TX
  • NPI 1407482003
  Medicare reassignment NPD

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

{
    "created_epoch": "1660262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1235867623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 N WASHINGTON AVE STE 200",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614436",
            "telephone_number": "432-332-9263",
            "fax_number": "432-332-9264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N WASHINGTON AVE STE 200",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614436",
            "telephone_number": "432-332-9263",
            "fax_number": "432-332-9264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTIMOE",
        "first_name": "KELLY",
        "middle_name": "RENE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-12",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1085712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fakeha Masood, MD
• Bradley Boyd Massey, CRNA
• Masters Hearing Aid Center, Inc.
• Arun Mathews, MD
• Matthew B Furst MD PA
• Pete A Mauro Jr.
• Tricia Mauro
• Steffany Paola Mavarez Toloza, MD
• Jose A Mayans, MD
• George Chidi Mba, MD

• Family Nurse Practitioner in Odessa, TX
• Providers in Odessa, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; 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.