Unknown Individual – Clinical Psychologist, NPI 1114069531

Unknown Individual is a healthcare provider. based in Kingsport, Tennessee. specializing in Clinical Psychologist. They hold a License No. P1713 (TN). The NPI Number for Unknown Individual is 1114069531

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114069531
Phone
(423) 392-6898
Address
404 E MARKET ST
Deactivation Date
8 May 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4233926898
Graduation Year
1985 (41 years ago)
PAC ID
2860659547
Professional Enrollment ID
I20120208000376
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 404 E MARKET ST

    KINGSPORT, TN 376604828

    Phone: (423) 392-6898

    Fax: (423) 392-6900

    Type: Mailing

  • 108 E MAIN ST

    STE 210A

    KINGSPORT, TN 376604257

    Phone: (423) 392-6898

    Fax: (423) 392-6900

    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.

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Medicare Utilization (FFS)

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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 37660)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1114069531.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Kingsport, Tennessee in registry-derived data.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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