Unknown Individual – Psychiatric/Mental Health Nurse Practitioner, NPI 1205904760

Unknown Individual is a healthcare provider. based in Hopkinsville, Kentucky. specializing in Psychiatric/Mental Health Nurse Practitioner. They hold a License No. 3001784 (KY). The NPI Number for Unknown Individual is 1205904760

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205904760
Phone
Not provided
Address
PO BOX 614
Deactivation Date
5 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2708218874
Graduation Year
1990 (36 years ago)
PAC ID
3072557438
Group Practice PAC ID
7911803440
Professional Enrollment ID
I20070508000679
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

  • PO BOX 614

    HOPKINSVILLE, KY 422410614

    Phone:

    Type: Mailing

  • 739, North Drive, Hopkinsville, Christian County, Kentucky, 42240, United States

    HOPKINSVILLE, KY 422402620

    Phone: (270) 886-9371

    Fax: (270) 886-5178

    Type: Location

  • 3999 Fort Campbell Blvd

    Hopkinsville, KY 422404929

    Phone: (270) 886-2205

    Fax: (270) 886-0392

    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 42241)

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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: 7911803440View full group profile

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1205904760 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Psychiatric/Mental Health Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Hopkinsville, Kentucky for Unknown Individual; download NPPES for the complete set.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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