Unknown Individual – Acute Care Nurse Practitioner, NPI 1164748547

Unknown Individual is a healthcare provider. based in Mccamey, Texas. specializing in Acute Care Nurse Practitioner. They hold a License No. 761955 (TX). The NPI Number for Unknown Individual is 1164748547

Main info

Organization
Inactive
18 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164748547
Phone
(432) 652-4010
Address
2500 HIGHWAY 305 SOUTH-B1200
Deactivation Date
9 December 2020

Doctor Profile

Medical School Name
UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE
Secondary Phone
9156528626
Graduation Year
2008 (18 years ago)
PAC ID
4981859899
Group Practice PAC ID
8628062320
Professional Enrollment ID
I20130226000492
Data current as of
20 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

  • 2500 HIGHWAY 305 SOUTH-B1200

    MCCAMEY, TX 797521200

    Phone: (432) 652-4010

    Fax: (432) 652-4013

    Type: Mailing

  • 2500 HIGHWAY 305 SOUTH

    MCCAMEY, TX 797520000

    Phone: (432) 652-4010

    Fax: (432) 652-4013

    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.

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 79752)

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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: 8628062320View full group profile
NameSpecialtyState
Physician AssistantTX
Nurse PractitionerTX
Nurse PractitionerTX
Physician AssistantTX

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1164748547 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Acute Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where in Texas is Unknown Individual registered?
Use Mccamey, Texas as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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