MR. ETIENNE CLEMENT POUFONG NP
NPI 1023626959
Nurse Practitioner - Psychiatric/Mental Health in Mountlake Terrace, WA
About Mr. Etienne Clement Poufong Np NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. ETIENNE CLEMENT POUFONG NP (NPI 1023626959) is an individual psychiatric/mental health provider in Mountlake Terrace, Washington, licensed in Washington (AP61426687) and active in the NPI registry since July 2020. He is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 3
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mr. Etienne Clement Poufong Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Etienne Poufong reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Mountlake Terrace, WA 98043
- Reassigned Medicare billing, Washington enrollment
- 777 clinicians in this Medicare group
Arlington, TX 76013
- Reassigned Medicare billing, Texas enrollment
- 14 clinicians in this Medicare group
Miami, FL 33130
- Reassigned Medicare billing, Colorado, District of Columbia, Texas and Washington enrollments
- 504 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 98043 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Etienne Poufong's NPI number?
The NPI number for Etienne Poufong is 1023626959. It was assigned to this individual provider in the NPPES registry on July 16, 2020.
Where is Etienne Poufong located?
Etienne Poufong practices at 1001 - Mountlake Terrace, Mountlake Terrace, WA 98043. The listed phone number is (469) 321-9543.
What is Etienne Poufong's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Etienne Poufong enrolled in Medicare?
Yes. Etienne Poufong is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Etienne Poufong's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Etienne Poufong reassigns Medicare benefits to 3 organizations: Mindful Therapy Group PC (Mountlake Terrace, WA), Hawkins Psychiatry PC (Arlington, TX) and Grow Healthcare Group PA (Miami, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Etienne Poufong's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Etienne Poufong accept?
Health plans from Blue Cross and Blue Shield of Texas, BridgeSpan Health Company, Cigna Healthcare, Oscar Insurance Company and Providence Health Plan and 2 other insurers list Etienne Poufong as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Etienne Poufong was last updated on June 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mr. Etienne Clement Poufong, NP · NPI 1023626959
Psychiatric/Mental Health physician in Mountlake Terrace, Washington. Individual provider, active in the CMS NPPES registry since July 16, 2020.
## Identity
- **NPI:** 1023626959 (Entity type: Individual)
- **Enumerated:** July 16, 2020
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** AP61426687 (Washington)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1001 - MOUNTLAKE TERRACE, Mountlake Terrace, WA 98043-7510
- **Phone:** (469) 321-9543
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Mindful Therapy Group PC (NPI 1316238678, Mountlake Terrace, WA); Hawkins Psychiatry PC (NPI 1003056607, Arlington, TX); Grow Healthcare Group PA (NPI 1245845932, Miami, FL) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** June 25, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1023626959) · Data from the CMS NPPES public registry.