Unknown Individual – Family Nurse Practitioner, NPI 1124117809

Unknown Individual is a healthcare provider. based in Chipley, Florida. specializing in Family Nurse Practitioner. They hold a License No. ARNP1196842 (FL). The NPI Number for Unknown Individual is 1124117809

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124117809
Phone
(850) 638-3400
Address
1410 BRICKYARD RD
Deactivation Date
24 August 2021
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

  • 1410, Brickyard Road, Chipley, Washington County, Florida, 32428, United States

    CHIPLEY, FL 32428

    Phone: (850) 638-3400

    Fax: (850) 638-9611

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $26.

Total Amount is formed as General ($26) + Research ($0) + Ownership ($0) = $26.

Last reported payment date: 2024-07-25 • Largest payer in this snapshot: ABBVIE INC. ($26).

Total Amount

$26

General + Research + Ownership

Payments

1

Total payment records

General Amount

$26

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-07-25

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$26
View all Open Payments →|Open Payments Risk Radar →

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 32428)

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Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1124117809 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
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 Family Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Chipley, Florida in registry-derived data.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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Unknown Individual

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1338, South Boulevard, Chipley, Washington County, Florida, 32428, United States
NPI: 1700030863