Individual
KIMBERLY GWEN METTETAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.F.N.P. CPMHNP
Contact information
Practice address
8626 AIRWAYS BLVD, SOUTHAVEN, MS 38671-2603
(662) 772-5937
(662) 772-5940
Mailing address
8626 AIRWAYS BLVD, SOUTHAVEN, MS 38671-2603
(662) 772-5937
(662) 772-5940
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R850409
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2018
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2018026553
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
5816
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
8391-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP136974
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP60842248
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R850409
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06787540
—
MS
05
—
382605901
—
TX
Enumeration date
09/20/2007
Last updated
07/14/2025
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