Unknown Individual – Family Nurse Practitioner, NPI 1669529491

Unknown Individual is a healthcare provider. based in Jackson, Missouri. specializing in Family Nurse Practitioner. They hold a License No. 104049 (MO). The NPI Number for Unknown Individual is 1669529491

Main info

Organization
Inactive
30 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1669529491
Phone
(573) 722-9191
Address
5569 LEXINGTON ST
Deactivation Date
10 February 2022

Doctor Profile

Medical School Name
UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Secondary Phone
5734757071
Graduation Year
1996 (30 years ago)
PAC ID
9830298330
Group Practice PAC ID
1951665439
Professional Enrollment ID
I20090210000402
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 5569, Lexington Street, Klaus Park Village, Jackson, Cape Girardeau County, Missouri, 63755, United States

    JACKSON, MO 637553827

    Phone: (573) 722-9191

    Fax: (573) 722-9393

    Type: Mailing

  • West Sturdivant Street, Advance, Stoddard County, Missouri, 63730, United States

    ADVANCE, MO 637307261

    Phone: (573) 722-9191

    Fax: (573) 722-9393

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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

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

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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 63755)

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Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1669529491 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Jackson, Missouri for Unknown Individual; expand the address list for detail.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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