Jennifer Mack

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

85353 Issued in NM

Practice address

5904 Holly Ave NE
Albuquerque, NM 87113-2472

Phone

(505) 298-2505

Fax

(505) 298-2985

NPI assigned

Oct 25, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Children's Urinary and Bowel Solutions Clinic and Consulting, LLC

  dba CUBS Clinic

  • Pediatric Nurse Practitioner
  • Castle Pines, CO
  • NPI 1033724570

  Pediatrics

  NPD Authorized official
• After Hours Pediatrics PC

  dba New Mexico Pediatrics

  • Pediatrics Physician
  • Albuquerque, NM
  • NPI 1588730360
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1003368150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 MONTGOMERY BLVD NE STE 201",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112467",
            "telephone_number": "505-298-2505",
            "fax_number": "505-298-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5904 HOLLY AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132472",
            "telephone_number": "505-298-2505",
            "fax_number": "505-298-2985"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9201 Montgomery Blvd NE Ste 201",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871112467",
            "country_code": "US",
            "telephone_number": "505-298-2505",
            "fax_number": "505-298-2985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-25",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NM",
            "license": "85353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nestor S Macias Jr., PHARM. D
• Santiago R. Macias, MD
• Valentina Abigail Macias
• Gina Maciel
• Natalia Victoria Maciel
• Jonathan Trimble Mack, EDM, LPCC
• Nicholas Mack
• Nhu N Mackara, LMHC
• John R. Mackenzie, CNP
• Regina Mackenzie, RN

• Pediatric Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Pediatric Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.