Unknown Individual – Psychiatric/Mental Health Nurse Practitioner, NPI 1639538010

Unknown Individual is a healthcare provider. based in Keokuk, Iowa. specializing in Psychiatric/Mental Health Nurse Practitioner. They hold a License No. G129143 (IA). The NPI Number for Unknown Individual is 1639538010

Main info

Organization
Inactive
11 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1639538010
Phone
(319) 795-3529
Address
812 BOULEVARD RD
Deactivation Date
12 July 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3197683700
Graduation Year
2015 (11 years ago)
PAC ID
6305141763
Group Practice PAC ID
6204739675
Professional Enrollment ID
I20160223000505
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

  • 812, Boulevard Road, Keokuk, Lee County, Iowa, 52632, United States

    KEOKUK, IA 526322505

    Phone: (319) 795-3529

    Type: Mailing

  • Burlington Ear Nose and Throat Clinic, 1225, South Gear Avenue, West Burlington, Des Moines County, Iowa, 52655, United States

    MERCY PLAZA, SUITE 251

    WEST BURLINGTON, IA 52655

    Phone: (319) 768-3700

    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.

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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 52632)

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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: 6204739675View full group profile

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1639538010 as the unique 10-digit identifier.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where in Iowa is Unknown Individual registered?
Use Keokuk, Iowa as the headline location for Unknown Individual here.
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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