Unknown Individual – Psychiatry Physician, NPI 1366512782

Unknown Individual is a healthcare provider. based in Burleson, Texas. specializing in Psychiatry Physician. They hold a License No. MD00027934 (WA). The NPI Number for Unknown Individual is 1366512782

Main info

Organization
Inactive
46 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1366512782
Phone
(509) 965-9580
Address
1711 TAYLOR BRIDGE CT
Deactivation Date
16 December 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5095754084
Graduation Year
1980 (46 years ago)
PAC ID
0547347361
Group Practice PAC ID
7618875022
Professional Enrollment ID
I20080403000381
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

  • 1711, Taylor Bridge Court, Burleson, Johnson County, Texas, 76028, United States

    BURLESON, TX 760286186

    Phone: (509) 965-9580

    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 76028)

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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: 7618875022View full group profile
NameSpecialtyState
Nurse PractitionerWA
Nurse PractitionerWA
Mental Health CounselorWA
Nurse PractitionerMN
Nurse PractitionerWA
-MO
Mental Health CounselorWA
Mental Health CounselorWA
Nurse PractitionerLA
Clinical Social WorkerWA

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1366512782 as the unique 10-digit identifier.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Where in Texas is Unknown Individual registered?
Use Burleson, Texas as the headline location for Unknown Individual here.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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