Unknown Individual – Adult Health Nurse Practitioner, NPI 1104255918

Adult Health Nurse Practitioner

Unknown Individual is a healthcare provider. based in Louisville, Kentucky. specializing in Adult Health Nurse Practitioner. They hold a License No. 5006617 (NC). The NPI Number for Unknown Individual is 1104255918

Main info

Organization

Inactive

13 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1104255918

Phone

(502) 327-9100

Address

140 WHITTINGTON PKWY

Deactivation Date

27 February 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

9197823456

Graduation Year

2013 (13 years ago)

PAC ID

9931330792

Group Practice PAC ID

9739150616

Professional Enrollment ID

I20140320001979

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

Provider Addresses for Unknown Individual

140 WHITTINGTON PKWY
SUITE 100
LOUISVILLE, KY 402224930
Phone: (502) 327-9100
Fax: (855) 632-8329
Type: Mailing
228 WESTINGHOUSE BLVD
STE 104
CHARLOTTE, NC 282736230
Phone: (866) 460-3567
Fax: (855) 632-8329
Type: Location
1540 Sunday Dr
Raleigh, NC 276076010
Phone: (919) 782-3456
Fax: (919) 783-1441
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $44.

Total Amount is formed as General ($44) + Research ($0) + Ownership ($0) = $44.

Last reported payment date: 2024-11-05 • Largest payer in this snapshot: Neurocrine BioSciences Inc. ($44).

Total Amount

$44

General + Research + Ownership

Payments

Total payment records

General Amount

$44

General payments

Research Amount

Research funding

Ownership Amount

Ownership interests

Ownership Count

Ownership records

Last Payment Date

2024-11-05

Latest reported date

Top Companies

Largest payers in this snapshot

Company	Amount
Neurocrine BioSciences Inc.	$44

View all Open Payments →|Open Payments Risk Radar →

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 40222)

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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: 9739150616View full group profile

Name	Specialty	State
ANDREW THOMAS IRONS (PA-C)	Physician Assistant	CA
DR. KENNETH M CARNES (M.D.)	N E U R O L O G Y	NC
FAITH ELLEN GEBHARDT (PA-C)	Physician Assistant	AR
KRISTEN MCCARTNEY WIDMER (M.D.)	N E U R O L O G Y	NC
DR. PATRICIA K. NASLUND (M.D.)	N E U R O L O G Y	NC
MR. THOMAS SCOTT BINFORD (PA)	Physician Assistant	NC
Unknown Individual	-	NC
MRS. VIRGINIA A JETHRO (PA-C)	Physician Assistant	NC
THINH NGUYEN (NP)	Nurse Practitioner	NC
DR. RICHARD W. TIM (M.D.)	N E U R O L O G Y	NC

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1104255918.

Does inactive mean outdated data for Unknown Individual?

Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Adult Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Louisville, Kentucky in registry-derived data.

Who maintains Unknown Individual's record?

Providers certify NPPES data; CMS hosts the public file you are viewing.