Unknown Individual – Pediatric Nurse Practitioner, NPI 1417922071

Unknown Individual is a healthcare provider. based in Kennesaw, Georgia. specializing in Pediatric Nurse Practitioner. They hold a License No. RN084156 (GA). The NPI Number for Unknown Individual is 1417922071

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1417922071
Phone
(770) 424-8222
Address
5150 STILESBORO RD NW
Deactivation Date
30 November 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

  • Stilesboro Road, Kennesaw, Cobb County, Georgia, 30152, United States

    SUITE 220

    KENNESAW, GA 301527744

    Phone: (770) 424-8222

    Fax: (770) 424-9962

    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.

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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 30152)

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Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1417922071.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Pediatric Nurse Practitioner in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Kennesaw?
Unknown Individual currently maps to Kennesaw, Georgia in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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