Unknown Individual – Family Nurse Practitioner, NPI 1407810658

Family Nurse Practitioner

Unknown Individual is a healthcare provider. based in Coquille, Oregon. specializing in Family Nurse Practitioner. They hold a License No. 200950045 FNP-PP (OR). The NPI Number for Unknown Individual is 1407810658

Main info

Organization

Inactive

21 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1407810658

Phone

(541) 396-3111

Address

790 E 5th St

Deactivation Date

16 January 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

5413963101

Graduation Year

2005 (21 years ago)

PAC ID

6800975897

Group Practice PAC ID

6901714591

Professional Enrollment ID

I20101221000993

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

Provider Addresses for Unknown Individual

790 E 5th St
Coquille, OR 974231755
Phone: (541) 396-3111
Fax: (541) 824-1702
Type: Location
Coquille Valley Hospital, 940, East 5th Street, Coquille, Coos County, Oregon, 97423, United States
COQUILLE, OR 974231699
Phone: (541) 396-3101
Fax: (541) 824-1702
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.

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 97423)

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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: 6901714591View full group profile

Name	Specialty	State
GERMAN SIERRA FERRER (MD)	Family Practice	OR
DR. JEAN PAUL COLON-PONS (M.D.)	Diagnostic Radiology	PR
EMILY ANNE REINIG (DO)	Family Practice, Osteopathic Manipulative Medicine	OR
NICOLE MARIE JANKE (FNP-C)	Nurse Practitioner	OR
ERIK JORDAN YOUNG (MD PHD)	Diagnostic Radiology, Nuclear Medicine, Diagnostic Radiology	WA
ANN ELISABETH KELLOGG (D.O.)	Family Practice	OR
NICHOLAS JONAS (MD)	General Surgery	MA
REBECCA ELIZABETH BRISCO (PA-C)	Physician Assistant	OR
MR. GLENN LAURENCE LEVINE (MD)	-	OR
JERRELL INGALLS (MD)	Diagnostic Radiology	NV

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?

Unknown Individual — NPI 1407810658 — is the standard way to identify this listing.

Is Unknown Individual excluded from programs when inactive?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Family Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Coquille, Oregon as a primary anchor for Unknown Individual unless the record lists multiple sites.

What does 'Individual Provider' mean on this profile?

Entity type tells you whether the number belongs to a person or an organization.