Unknown Individual – Family Nurse Practitioner, NPI 1124395892

Unknown Individual is a healthcare provider. based in Wytheville, Virginia. specializing in Family Nurse Practitioner. They hold a License No. 0001187004 (VA). The NPI Number for Unknown Individual is 1124395892

Main info

Organization
Inactive
16 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124395892
Phone
(276) 223-3200
Address
710 W RIDGE RD STE 220
Deactivation Date
10 April 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2767838185
Graduation Year
2010 (16 years ago)
PAC ID
1456505288
Group Practice PAC ID
1254387475
Professional Enrollment ID
I20130204000145
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 710 W RIDGE RD STE 220

    WYTHEVILLE, VA 243821095

    Phone: (276) 223-3200

    Fax: (276) 223-0617

    Type: Mailing

  • 610 Campus Dr

    Abingdon, VA 242102589

    Phone: (276) 525-1479

    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 24382)

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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: 1254387475View full group profile
NameSpecialtyState
Nurse PractitionerVA
Mental Health CounselorVA
Mental Health CounselorVA
Nurse PractitionerTN
Mental Health CounselorVA
Clinical Social WorkerVA
Nurse PractitionerVA
Clinical Social WorkerVA
Clinical Social WorkerVA
-VA

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1124395892.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Wytheville, Virginia for Unknown Individual; download NPPES for the complete set.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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