Unknown Individual – Psychiatry Physician, NPI 1205817210

Unknown Individual is a healthcare provider. based in Broken arrow, Oklahoma. specializing in Psychiatry Physician. They hold a License No. 18071 (OK). The NPI Number for Unknown Individual is 1205817210

Main info

Organization
Inactive
35 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205817210
Phone
(918) 813-7682
Address
PO BOX 1325
Deactivation Date
9 May 2022

Doctor Profile

Medical School Name
UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
Secondary Phone
-
Graduation Year
1991 (35 years ago)
PAC ID
0547259699
Professional Enrollment ID
I20120203000021
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

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Provider Addresses for Unknown Individual

  • PO BOX 1325

    BROKEN ARROW, OK 740131325

    Phone: (918) 813-7682

    Type: Mailing

  • American Streetedge Self-Defense and Personal Protection, 309, North Redbud Avenue, Broken Arrow, Tulsa, Oklahoma, 74012, United States

    BROKEN ARROW, OK 740122376

    Phone: (918) 813-7682

    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

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.

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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 74013)

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Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1205817210.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Psychiatry Physician in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Broken Arrow, Oklahoma.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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