Mr Etienne Clement Poufong, NP in Mountlake Terrace, WA

Mr Etienne Clement Poufong, NP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Mountlake Terrace, Washington. His current practice location is 1001 - Mountlake Terrace, Mountlake Terrace, Washington. You can reach out to his office (for appointments etc.) via phone at (469) 321-9543.

Mr Etienne Clement Poufong is licensed to practice in Washington (license number AP61426687) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1023626959.

Contact Information

	Mr Etienne Clement Poufong, NP
	1001 - Mountlake Terrace, Mountlake Terrace, WA 98043-7510
	(469) 321-9543
	Not Available

Map and Direction

Provider's Profile

Full Name	Mr Etienne Clement Poufong
Gender	Male
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	1001 - Mountlake Terrace, Mountlake Terrace, Washington
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1023626959
Provider Enumeration Date: 07/16/2020
Last Update Date: 06/25/2023

Medicare PECOS Information:

PECOS PAC ID: 3173923166
Enrollment ID: I20210614000427

Medical Identifiers

Medical identifiers for Mr Etienne Clement Poufong such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1023626959	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	AP146155 (Texas)	Secondary
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	AP61426687 (Washington)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Etienne Clement Poufong allows following entities to bill medicare on his behalf.

Entity Name	Hawkins Psychiatry Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1003056607 PECOS PAC ID: 5395893804 Enrollment ID: O20090511000117

Entity Name	Grow Healthcare Group Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1245845932 PECOS PAC ID: 3476961368 Enrollment ID: O20220525002138

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Etienne Clement Poufong is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mr Etienne Clement Poufong, NP 708 Clement Dr, Cedar Hill, TX 75104-7352 Ph: (469) 321-9543	Mr Etienne Clement Poufong, NP 1001 - Mountlake Terrace, Mountlake Terrace, WA 98043-7510 Ph: (469) 321-9543

Reviews and Comments

Nurse Practitioner Nurses in Mountlake Terrace, WA

Christina Lynn Gelder, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6100 219th St Sw Ste 370, Mountlake Terrace, WA 98043 Phone: 888-777-1945 Fax: 805-413-9099
Van Ngoc Tran, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6007 244th St Sw Ste B, Mountlake Terrace, WA 98043 Phone: 425-640-4830
Allison Carole Cothern, RN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 6505 216th St Sw Ste 100, Mountlake Terrace, WA 98043 Phone: 205-955-0203
Dr. Iman M Yunis, DNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 21907 64th Ave W Ste 200, Mountlake Terrace, WA 98043 Phone: 470-966-0299
Mr. Chad Lawrence Jacobs, PMHNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 21907 64th Ave W Ste 200, Mountlake Terrace, WA 98043 Phone: 317-695-8041
Adam D Barnett, DOCTOR OF NURSING PR Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6505 216th St Sw Ste 100, Mountlake Terrace, WA 98043 Phone: 512-537-7308

Mr Etienne Clement Poufong, NP - Medicare Nurse Practitioner in Mountlake Terrace, WA