Jesse Lauren Pack, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

327183 Issued in AZ

Practice address

6242 E Arbor Ave Ste 118
Mesa, AZ 85206-1309

Phone

(602) 805-4914

Fax

(602) 805-4917

NPI assigned

Nov 29, 2021

Last updated

Aug 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX, AZ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Canyon Family Medicine PLLCGroup PAC ID 0547650350, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Canyon Family Medicine PLLC

  dba Canyon Family Medicine

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1780349902
  Medicare reassignment Care Compare group NPD
• Corner Health Medical Group P a

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1205689171
  Medicare reassignment NPD
• David P Ellent PLLC

  • Pulmonary Disease Physician
  • Spring, TX
  • NPI 1245777440
  Medicare reassignment NPD
• David P Ellent PLLC

  dba Genesis Medical Group

  • Clinical Medical Laboratory
  • Kingwood, TX
  • NPI 1891348959
  NPD

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1255098075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6242 E ARBOR AVE STE 118",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061309",
            "telephone_number": "602-805-4914",
            "fax_number": "602-805-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6242 E ARBOR AVE STE 118",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061309",
            "telephone_number": "602-805-4914",
            "fax_number": "602-805-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "JESSE",
        "middle_name": "LAUREN",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-29",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "327183",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "327183",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN",
            "identifier": "327183",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN",
            "identifier": "1139965",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://app.kareo.com",
            "affiliation": "N",
            "endpointDescription": "Tebra",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Tebra",
            "address_1": "6242 E Arbor Ave Ste 118",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852061309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cynthia Arely Pacheco, MSOT, OTR
• Lorena Venita Pacheco
• Michael A Pachtman, M.D.
• Pacific Behavioral Center Inc
• Pacific Developmental Abilities, LLC
• Blair J Packard II, PT
• Kendal Packer
• Nina Padilla-Hurst
• Brionna Padilla
• Nayely Padilla, MSW

• Family Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.