Unknown Individual – Family Nurse Practitioner, NPI 1154858751

Family Nurse Practitioner

Unknown Individual is a healthcare provider. based in Cleveland, Mississippi. specializing in Family Nurse Practitioner. They hold a License No. 902008 (MS). The NPI Number for Unknown Individual is 1154858751

Main info

Organization

Inactive

9 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1154858751

Phone

(662) 402-8194

Address

2460 HIGHWAY 8

Deactivation Date

30 June 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

Graduation Year

2017 (9 years ago)

PAC ID

6800161589

Group Practice PAC ID

6305995895

Professional Enrollment ID

I20171005001415

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Loading map...

Provider Addresses for Unknown Individual

8, Cleveland Avenue, Long Eaton, Nottingham, Derbyshire, East Midlands, England, NG10 2BT, United Kingdom
CLEVELAND, MS 387329616
Phone: (662) 402-8194
Type: Mailing
104, East Sunflower Road, Cleveland, Bolivar County, Mississippi, 38732, United States
CLEVELAND, MS 387322830
Phone: (662) 721-1399
Fax: (662) 721-1380
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 38732)

Loading plans...

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 6305995895View full group profile

Name	Specialty	State
MATTHEW BEAR (DO)	Internal Medicine	TX
DR. STEVEN GLENN CLARK (M.D)	Internal Medicine	MS
CLARE ADAMS MOORE (FNP)	Nurse Practitioner	MS
Unknown Individual	-	MS
DR. DAVID WALT (MD)	-	MS
DR. BRADLEY REX BAUGH (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	MS
WILLIAM BLAKE MCKIBBIN (M.D.)	General Surgery	VA
DR. DEREK MILES (MD)	U R O L O G Y	MS
DR. JOHN A CARR (MD)	Thoracic Surgery	MI
BROOKE NICOLE TIMS (RN, CFNP)	Nurse Practitioner	MS