Unknown Individual – Adult Health Nurse Practitioner, NPI 1114051877

Adult Health Nurse Practitioner

Unknown Individual is a healthcare provider. based in Austin, Texas. specializing in Adult Health Nurse Practitioner. They hold a License No. AP109542 (TX). The NPI Number for Unknown Individual is 1114051877

Main info

Organization

Inactive

27 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1114051877

Phone

(512) 431-0620

Address

1803 W 29TH ST

Deactivation Date

27 February 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

5124596503

Graduation Year

1999 (27 years ago)

PAC ID

3173771607

Group Practice PAC ID

6002091261

Professional Enrollment ID

I20120907000156

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

1803 W 29TH ST
AUSTIN, TX 787031807
Phone: (512) 431-0620
Type: Mailing
3708 JEFFERSON ST
STE A
AUSTIN, TX 787316206
Phone: (512) 459-6503
Fax: (512) 454-7453
Type: Location
2200 PARK BEND DR STE 300
AUSTIN, TX 787585386
Phone: (512) 651-8644
Fax: (512) 651-8635
Type: Mailing

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 78703)

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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: 6002091261View full group profile

Name	Specialty	State
CARLA ZERI MARCHESI (FNP-C)	-	TX
DR. BERNARD AUGUST JR. HILDEBRAND (MD)	R H E U M A T O L O G Y	TX
DR. JENNIFER M. ARGUMEDO (MD)	E N D O C R I N O L O G Y	TX
JOANNE KNIGHT (D.O.)	Family Practice	TX
DR. RAUDEL SZAROLETTA RODRIGUEZ (M.D.)	Internal Medicine, Hospitalist	TX
MR. THEODORE CARROLL KLEM (M.D.)	Internal Medicine	TX
CHANEL DIOR COCHRAN	Nurse Practitioner	TX
MRS. AMANDA LEE KYLE (PA)	Physician Assistant	TX
BRIAN MICHAEL KANATZAR (D.O.)	Internal Medicine	TX
MARCO A. HINOJOSA (M.D.)	Internal Medicine, Hospitalist	TX

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?

The registry entry for Unknown Individual shows NPI 1114051877.

What should I verify if Unknown Individual is listed inactive?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

Which specialty label fits Unknown Individual?

NPPES ties Unknown Individual to Adult Health Nurse Practitioner in the taxonomy section. Clinical services aligned with this taxonomy classification.

What city is tied to Unknown Individual?

The directory associates Unknown Individual with Austin, Texas. Check all listed addresses for suites or satellite offices.

Who maintains Unknown Individual's record?

Providers certify NPPES data; CMS hosts the public file you are viewing.