Unknown Individual – Family Nurse Practitioner, NPI 1104885359

Unknown Individual is a healthcare provider. based in Aberdeen, Mississippi. specializing in Family Nurse Practitioner. They hold a License No. R855606 (MS). The NPI Number for Unknown Individual is 1104885359

Main info

Organization
Inactive
24 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104885359
Phone
(662) 369-8018
Address
305 HIGHWAY 145 N
Deactivation Date
17 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6623692455
Graduation Year
2002 (24 years ago)
PAC ID
5890688048
Group Practice PAC ID
0244505840
Professional Enrollment ID
I20040203000653
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

Provider Addresses for Unknown Individual

  • 305 HIGHWAY 145 N

    ABERDEEN, MS 397302370

    Phone: (662) 369-8018

    Fax: (662) 369-7974

    Mailing address matches the actual address.

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 39730)

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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: 0244505840View full group profile
NameSpecialtyState
Emergency Medicine, NeurologyLA
Nurse PractitionerMS
Nurse PractitionerMS
Family PracticeMS
-AL
Nurse PractitionerMS
Nurse PractitionerMS
-MS
Nurse PractitionerMS
Emergency Medicine, Family PracticeIN

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1104885359 — is the standard way to identify this listing.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Aberdeen, Mississippi; more addresses can appear in NPPES.
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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