Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kimberly Gwen Mettetal, CFNPCPMHNP

Individual provider Family Nurse Practitioner · NPI 1194911453

Kimberly Gwen Mettetal, CFNPCPMHNP is a Nurse Practitioner in Southaven, Mississippi. Qualified in 1999, 27 years ago. Practices with The Gulf Coast Center, a 20-clinician group, works from 9 locations, accepts Medicare assignment and offers telehealth. Licensed in Minnesota, Missouri, Mississippi and Oregon and 3 more.

Years since qualifying
27
Licensed in
MN, MO, MS, OR, TX, WA
In the registry since
2007
Specialties on file
8
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Practice location Address checks out

8626 Airways Blvd
Southaven, MS 38671-2603
Phone: (662) 772-5937
Fax: (662) 772-5940
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (8)

  • 4050 Coon Rapids Blvd Nw, Coon Rapids, MN 55433-2522 — (763) 236-6000
  • 2505 Mission Dr, Jefferson City, MO 65109-9508 — (573) 681-3000
  • 311 E Main St, Senatobia, MS 38668-2215 — (662) 772-5937
  • 1015 Nw 22nd Ave, Portland, OR 97210-3025 — (503) 413-7711
  • 2001 S Medford Dr, Lufkin, TX 75901-6260 — (936) 639-1141
  • 2211 Ne 139th St, Vancouver, WA 98686-2742 — (360) 487-1000
  • 700 S Park St, Madison, WI 53715-1830 — (608) 251-6100
  • 1629 E Division St, River Falls, WI 54022-1571 — (715) 307-6000

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence R850409 (MS)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence R850409 (MS)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 2018026553 (MO)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence AP60842248 (WA)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 8391-33 (WI)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 2018 (OR)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 5816 (MN)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence AP136974 (TX)

Record details

NPI number1194911453
Entity typeIndividual (Type 1)
GenderFemale
Credentials CFNPCPMHNP
Sole proprietorNo
NPI enumeratedSeptember 20, 2007
Last updated in NPPESJuly 14, 2025
Certification dateJuly 14, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1999 (27 years in practice)
Group practice The Gulf Coast Center — 20 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Southaven