MEDICARE: KATHRYN METTMAN PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0997134-NP	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	C-APN.0001965-C-NP	CO
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP128882	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	100098080C	OTHER	KS	SED WAIVER

General Provider Information

NPI Number	:	1063889525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN METTMAN PMHNP

Provider Business Mailing Address
First Line	:	1430 COLLIER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 OAK SPRINGS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-2537
Country	:	US
Telephone Number	:	512-447-4141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	10/24/2024

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