Unknown Individual – Family Nurse Practitioner, NPI 1619955119

Unknown Individual is a healthcare provider. based in Grove, Oklahoma. specializing in Family Nurse Practitioner. They hold a License No. R000040077 (OK). The NPI Number for Unknown Individual is 1619955119

Main info

Organization
Inactive
29 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619955119
Phone
(918) 786-8448
Address
1121 NEO LOOP
Deactivation Date
2 November 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9187868448
Graduation Year
1997 (29 years ago)
PAC ID
5890760490
Group Practice PAC ID
2567361165
Professional Enrollment ID
I20040827000522
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience18
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Grove, Trilofos, Δήμος Θέρμης, Thessaloniki Regional Unit, Central Macedonia, Macedonia and Thrace, 57500, Greece

    GROVE, OK 743446046

    Phone: (918) 786-8448

    Fax: (918) 786-3483

    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.

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 74344)

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Provider's Procedures

Unknown Individual performs procedures in Family Nurse Practitioner. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
NURSE PRACTITIONEROK20610Aspiration and/or injection of large joint or joint capsule1817
NURSE PRACTITIONEROK83036Hemoglobin A1C level7658
NURSE PRACTITIONEROK85610Blood test, clotting time3613
NURSE PRACTITIONEROK90670Pneumococcal vaccine for injection into muscle1616

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: 2567361165View full group profile
NameSpecialtyState
Unknown Individual
-AR
ASHISH MATHUR (MD)
-AR
JODY NICHOLS (L.C.S.W.)
-AR
MINDY LEIGH WATKINS (CNP)
-MN
DR. ROY DALE CLEMENS (M.D.)
-AR

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1619955119.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
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.
Does Unknown Individual practice in Oklahoma?
You will see Grove, Oklahoma on file for Unknown Individual alongside any extra practice locations.
What if Grove, Oklahoma seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.