Unknown Individual – Family Nurse Practitioner, NPI 1912069600

Family Nurse Practitioner

Unknown Individual is a healthcare provider. based in Centerville, Ohio. specializing in Family Nurse Practitioner. They hold a License No. 310744 (OH). The NPI Number for Unknown Individual is 1912069600

Main info

Organization

Inactive

21 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1912069600

Phone

(937) 401-6228

Address

1997 Miamisburg Centerville Rd

Deactivation Date

21 June 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

9374272225

Graduation Year

2005 (21 years ago)

PAC ID

9537217930

Group Practice PAC ID

0547536187

Professional Enrollment ID

I20090423000000

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience32

Completeness75

Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

1997 Miamisburg Centerville Rd
Centerville, OH 454593811
Phone: (937) 401-6228
Fax: (937) 401-6447
Type: Location
100 Kettering Way
Franklin, OH 450051155
Phone: (937) 458-4700
Fax: (937) 458-4737
Type: Location
450 Washington Jackson Rd Ste F
Eaton, OH 453208699
Phone: (937) 456-8376
Fax: (937) 456-8377
Type: Location
600 W Main St
Troy, OH 453732928
Phone: (937) 980-7010
Fax: (937) 980-7019
Type: Location
3535 Southern Blvd
Kettering, OH 454291221
Phone: (937) 395-8166
Fax: (937) 395-8347
Type: Location
6147 State Route 122
Middletown, OH 450055201
Phone: (513) 261-3410
Fax: (513) 261-3419
Type: Location
4000 Miamisburg Centerville Rd
Miamisburg, OH 453427615
Phone: (937) 384-8791
Fax: (937) 384-8729
Type: Location
8701 Old Troy Pike
Huber Heights, OH 454241066
Phone: (937) 558-3338
Fax: (937) 558-3349
Type: Location
1141 N Monroe Dr
Xenia, OH 453851619
Phone: (937) 352-2500
Fax: (937) 352-3501
Type: Location
3535 Pentagon Blvd
Beavercreek, OH 454311705
Phone: (937) 702-4500
Fax: (937) 702-4509
Type: Location
405 W Grand Ave
Dayton, OH 454057538
Phone: (937) 723-3211
Fax: (937) 723-4609
Type: Location
1470 WISBEY RD
BLANCHESTER, OH 451077777
Phone: (513) 646-0025
Type: Location
Mound Battery Road, Long Leaf Acres, Wilmington, New Hanover County, North Carolina, 28405, United States
WILMINGTON, OH 451779061
Phone: (614) 560-9899
Type: Mailing

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

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 45459)

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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: 0547536187View full group profile

Name	Specialty	State
DR. DYLAN ROBERT BLACK (DC)	C H I R O P R A C T I C	OH
KELLY CHRISTINE BEASLEY (DPT)	Physical Therapist In Private Practice	OH
DR. JUSTIN VINSON (D.C.)	C H I R O P R A C T I C	OH
ALLISON MICHELLE HARPER (CNP)	Nurse Practitioner	OH
DR. DEREK ROBERT BLACK (D.C.)	C H I R O P R A C T I C	OH
LAURA E WEBER (FNP-C)	-	OH