Unknown Individual – Family Nurse Practitioner, NPI 1790024453

Family Nurse Practitioner

Unknown Individual is a healthcare provider. based in Saint joseph, Missouri. specializing in Family Nurse Practitioner. They hold a License No. 2013002934 (MO). The NPI Number for Unknown Individual is 1790024453

Main info

Organization

Inactive

14 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1790024453

Phone

(816) 232-6818

Address

2303 VILLAGE DR

Deactivation Date

19 June 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8162325113

Graduation Year

2012 (14 years ago)

PAC ID

5092951293

Group Practice PAC ID

5294791695

Professional Enrollment ID

I20130412000467

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

2303 VILLAGE DR
SAINT JOSEPH, MO 645064954
Phone: (816) 232-6818
Fax: (816) 232-6823
Type: Location
803 W US Highway 71
Savannah, MO 644851151
Phone: (816) 324-3121
Type: Location
503 S 6th St
Saint Joseph, MO 645012224
Phone: (816) 233-8536
Type: Location
5001 Lake Ave
Saint Joseph, MO 645041170
Phone: (816) 238-7788
Type: Location
1303 State St
Mound City, MO 644701717
Phone: (660) 442-5464
Type: Location
101 Cross St
Hamilton, MO 646448311
Phone: (816) 583-2151
Type: Location
313 S US Highway 169
Gower, MO 644549116
Phone: (816) 424-6427
Type: Location
707 Victory Ln
Cainsville, MO 646329506
Phone: (660) 893-5750
Type: Location
109 N Main St
Braymer, MO 646249325
Phone: (660) 645-2218
Type: Location
2303 Village Dr
Saint Joseph, MO 645064954
Phone: (816) 232-6818
Fax: (816) 232-6823
Type: Location
305 Rhode Island St
King City, MO 644639622
Phone: (660) 535-4347
Type: Location
1515 SAINT JOSEPH AVE
SAINT JOSEPH, MO 645052631
Phone: (816) 233-3338
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 64506)

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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: 5294791695View full group profile

Name	Specialty	State
DR. JOSHUA MIDDENDORF (D.C.)	C H I R O P R A C T I C	MO
DR. THOMAS W ALDERSON (M.D)	-	MO
ALLYN NEILL SMITH (DC)	C H I R O P R A C T I C	MO
CYRUS DANIEL SMITH (D.O.)	-	MO
DR. JUSTIN RICHARD CASEY (D.C.)	C H I R O P R A C T I C	MO
HANNAH GRACE SPIEGEL (PT, DPT)	Physical Therapist In Private Practice	MO
SARAH RENEE WIEDERHOLT (MD)	-	MO
DR. AARON D JONES (D.P.T.)	Physical Therapist In Private Practice	MO
DEREK M KENDALL (DPT)	Physical Therapist In Private Practice	MO
DR. AARON CLARY (D.C.)	C H I R O P R A C T I C	KS

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?

Public records show Unknown Individual under NPI 1790024453.

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 Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.

Can patients visit Unknown Individual in Saint Joseph, Missouri?

For routing, start with Saint Joseph, Missouri for Unknown Individual, then verify phone and hours locally.

Can I export Unknown Individual's record?

You can download the official NPPES record; we summarize key fields for readability.