Unknown Individual – Psychiatry Physician, NPI 1780796979

Unknown Individual is a healthcare provider. based in Poplar bluff, Missouri. specializing in Psychiatry Physician. They hold a License No. C42672 (CA). The NPI Number for Unknown Individual is 1780796979

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1780796979
Phone
(573) 778-4603
Address
1500 N WESTWOOD BLVD
Deactivation Date
14 December 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • John J. Pershing VA Medical Center, 1500, North Westwood Boulevard, Poplar Bluff, Butler County, Missouri, 63901, United States

    JOHN J. PERSHING VA MEDICAL CENTER

    POPLAR BLUFF, MO 63901

    Phone: (573) 778-4603

    Type: Location

  • 2609, Barron Road, Loma Linda, Poplar Bluff, Butler County, Missouri, 63901, United States

    POPLAR BLUFF, MO 639011915

    Phone: (573) 785-7588

    Type: Mailing

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.

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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 63901)

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Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1780796979 when you need to reference Unknown Individual in forms, claims, or directories.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Poplar Bluff, Missouri for Unknown Individual based on available NPPES addresses.
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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