Unknown Individual – Family Nurse Practitioner, NPI 1023838315

Unknown Individual is a healthcare provider. based in Hulbert, Oklahoma. specializing in NURSE PRACTITIONER. They hold a License No. 220535 (OK). The NPI Number for Unknown Individual is 1023838315

Main info

Organization
Inactive
2 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1023838315
Phone
(918) 772-2879
Address
124 E MAIN ST
Deactivation Date
14 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2024 (2 years ago)
PAC ID
4688103617
Group Practice PAC ID
3678482635
Professional Enrollment ID
I20251125001043
Address ID
OK744643234TA1500XSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

3,299 NURSE PRACTITIONER in OK

Provider Addresses for Unknown Individual

  • 124 E MAIN ST

    HULBERT, OK 744418902

    Phone: (918) 772-2879

    Mailing address matches the actual address.

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.

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.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-11-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250121002124INurse PractitionerOKTBD
I20251125001043INurse PractitionerTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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 74441)

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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: 3678482635View full group profile
NameSpecialtyState
Nurse PractitionerOK
Family Practice, Internal MedicineOK
Nurse PractitionerOK
Nurse PractitionerOK
Nurse PractitionerOK
Physician AssistantOK
Nurse PractitionerOK
O B S T E T R I C S/ G Y N E C O L O G YNY
Nurse PractitionerOK
Physician AssistantAR

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1023838315 is assigned to Unknown Individual under the national enumeration system.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Hulbert, Oklahoma for Unknown Individual based on available NPPES addresses.
What if Hulbert, Oklahoma seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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