Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1386747392

Unknown Individual is a healthcare provider. based in Memphis, Missouri. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 134066 (MO). The NPI Number for Unknown Individual is 1386747392

Main info

Organization
Inactive
28 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1386747392
Phone
(660) 342-6654
Address
RR 1 BOX 175
Deactivation Date
17 April 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5208742000
Graduation Year
1998 (28 years ago)
PAC ID
3870554140
Group Practice PAC ID
1355616517
Professional Enrollment ID
I20130626000872
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

  • RR 1 BOX 175

    MEMPHIS, MO 635559609

    Phone: (660) 342-6654

    Type: Mailing

  • RR 1 BOX 53

    MEMPHIS, MO 635559767

    Phone: (660) 465-8511

    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.

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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 63555)

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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: 1355616517View full group profile

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1386747392 uniquely identifies Unknown Individual in U.S. healthcare data.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Memphis, Missouri?
If you are local to Memphis, Missouri, Unknown Individual may be relevant to your search.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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