Unknown Individual – Psychiatric/Mental Health Nurse Practitioner, NPI 1790816601

Unknown Individual is a healthcare provider. based in Gray, Tennessee. specializing in Psychiatric/Mental Health Nurse Practitioner. They hold a License No. 0024164719 (VA). The NPI Number for Unknown Individual is 1790816601

Main info

Organization
Inactive
21 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1790816601
Phone
(423) 467-3600
Address
PO BOX 9054
Deactivation Date
28 August 2025

Doctor Profile

Medical School Name
LINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
Secondary Phone
2764314370
Graduation Year
2005 (21 years ago)
PAC ID
9032289954
Group Practice PAC ID
2860302320
Professional Enrollment ID
I20080604000538
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

  • PO BOX 9054

    GRAY, TN 376159054

    Phone: (423) 467-3600

    Fax: (423) 467-3644

    Type: Mailing

  • 34084 WILDERNESS RD

    JONESVILLE, VA 242637899

    Phone: (276) 346-3590

    Fax: (423) 467-3644

    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.

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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 37615)

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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: 2860302320View full group profile

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1790816601 — the number used across U.S. healthcare to identify this provider.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Gray?
Public fields place Unknown Individual around Gray, Tennessee. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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