Unknown Individual – Physician Assistant, NPI 1215046404

Unknown Individual is a healthcare provider. based in Branson, Missouri. specializing in Physician Assistant. They hold a License No. 2002025182 (MO). The NPI Number for Unknown Individual is 1215046404

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1215046404
Phone
(417) 335-7128
Address
101 SKAGGS ROAD
Deactivation Date
18 September 2025
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

  • 101, Skaggs Road, Branson, Taney County, Missouri, 65616, United States

    SUITE 402

    BRANSON, MO 65616

    Phone: (417) 335-7128

    Fax: (417) 334-5231

    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 65616)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1215046404 — the number used across U.S. healthcare to identify this provider.
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 Physician Assistant. Clinical services aligned with this taxonomy classification.
Where in Missouri is Unknown Individual registered?
Use Branson, Missouri as the headline location for Unknown Individual here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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