Unknown Individual – Nurse Practitioner, NPI 1154545192

Unknown Individual is a healthcare provider. based in Austin, Texas. specializing in Nurse Practitioner. They hold a License No. 655360 (TX). The NPI Number for Unknown Individual is 1154545192

Main info

Organization
Inactive
29 Years Of Experience
Name
Unknown Individual
NPI
1154545192
Phone
(512) 462-3627
Address
4303 VICTORY DR
Deactivation Date
17 May 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5124623627
Graduation Year
1997 (29 years ago)
PAC ID
1557428349
Group Practice PAC ID
8921080409
Professional Enrollment ID
I20090323000314
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

  • 4303 VICTORY DR

    AUSTIN, TX 787048870

    Phone: (512) 462-3627

    Fax: (512) 462-3431

    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 78704)

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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: 8921080409View full group profile

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1154545192.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Austin, Texas; more addresses can appear in NPPES.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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