Unknown Individual – Pediatric Nurse Practitioner, NPI 1306877196

Unknown Individual is a healthcare provider. based in Liberty lake, Washington. specializing in Pediatric Nurse Practitioner. They hold a License No. AP30001853 (WA). The NPI Number for Unknown Individual is 1306877196

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1306877196
Phone
(509) 747-3081
Address
PO BOX 421
Deactivation Date
23 June 2022

Contacts

Secure Messaging
ehartleykeith309400@wm.providencedirect.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 421, Liberty Lane, Evesham Township, Burlington County, New Jersey, 08053-5344, United States

    LIBERTY LAKE, WA 990190421

    Phone: (509) 747-3081

    Fax: (509) 227-7070

    Type: Mailing

  • 1919, South Grand Boulevard, Manito / Cannon Hill, Spokane, Spokane County, Washington, 99203, United States

    SPOKANE, WA 992032347

    Phone: (509) 747-3081

    Fax: (509) 227-7070

    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 99019)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1306877196.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Pediatric Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Liberty Lake, Washington in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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