Unknown Individual – Family Nurse Practitioner, NPI 1114454139

Unknown Individual is a healthcare provider. based in Knox, Indiana. specializing in Family Nurse Practitioner. They hold a License No. 28140263A (IN). The NPI Number for Unknown Individual is 1114454139

Main info

Organization
Inactive
9 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114454139
Phone
(574) 310-2189
Address
10037 E 50 S
Deactivation Date
31 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
574772603024
Graduation Year
2017 (9 years ago)
PAC ID
6204104540
Group Practice PAC ID
9537229802
Professional Enrollment ID
I20170609001675
Data current as of
20 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

  • East 50 South, Knox, Starke County, Indiana, 46534, United States

    KNOX, IN 465348230

    Phone: (574) 310-2189

    Type: Mailing

  • 2, Pearl Street, Mount Vernon, Knox County, Ohio, 43050, United States

    KNOX, IN 465341416

    Phone: (574) 207-5050

    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 46534)

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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: 9537229802View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1114454139.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Knox, Indiana may find Unknown Individual in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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