Individual Healthcare Provider
Kimberly Gwen Mettetal, C.F.N.P. CPMHNP
Provider's NPPES record last updated: July 14, 2025
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1194911453
- Primary Specialty
- Nurse Practitioner — Psychiatric/Mental Health
- Practice Location
- Southaven, Mississippi
- Sole Proprietor
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 18, 2026, 10:10 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Nurse Practitioner
Psychiatric/Mental Health
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LP0808X Nurse Practitioner
Family
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LF0000X
Provider-Reported License Information
- Nurse Practitioner (Mississippi)
- R850409
- Nurse Practitioner (Mississippi)
- R850409
- Nurse Practitioner (Missouri)
- 2018026553
- Nurse Practitioner (Washington)
- AP60842248
- Nurse Practitioner (Wisconsin)
- 8391-33
- Nurse Practitioner (Oregon)
- 2018
- Nurse Practitioner (Minnesota)
- 5816
- Nurse Practitioner (Texas)
- AP136974
Practice Locations
Practice Location
8626 Airways Blvd
Southaven, Mississippi 38671-2603
Phone: (662) 772-5937
Additional Practice Location
2505 Mission Dr
Jefferson City, Missouri 65109-9508
Phone: (573) 681-3000
Additional Practice Location
311 E Main St
Senatobia, Mississippi 38668-2215
Phone: (662) 772-5937
Fax: (662) 772-5940
Additional Practice Location
1015 Nw 22nd Ave
Portland, Oregon 97210-3025
Phone: (503) 413-7711
Additional Practice Location
2211 Ne 139th St
Vancouver, Washington 98686-2742
Phone: (360) 487-1000
Additional Practice Location
4050 Coon Rapids Blvd Nw
Coon Rapids, Minnesota 55433-2522
Phone: (763) 236-6000
Additional Practice Location
1629 E Division St
River Falls, Wisconsin 54022-1571
Phone: (715) 307-6000
Additional Practice Location
700 S Park St
Madison, Wisconsin 53715-1830
Phone: (608) 251-6100
Additional Practice Location
2001 S Medford Dr
Lufkin, Texas 75901-6260
Phone: (936) 639-1141
Fax: (936) 634-8601
Record Information
- Enumeration Date
- September 20, 2007
- Provider's NPPES Record Last Updated
- July 14, 2025
- Certification Date
- July 14, 2025
- NPISignal NPPES Dataset
- August 2026
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