Individual provider Active NPI

Jennifer Venus Mackenzie, AG-ACNP-BC

  • Acute Care Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1265314280
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R256014 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1544
Phone
(410) 328-8667
NPI assigned
Jul 22, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R256014 MD Primary
Acute Care Nurse Practitioner 363LA2100X 0024195196 VA

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1544

Mailing address

1216 Kathryn Rd
Silver Spring, MD 20904-2175
Phone (907) 687-0069

Other practice location 1

1060 First Colonial Rd
Virginia Beach, VA 23454-3002
Phone (757) 395-2323

Other names 1

  • Jennifer V Mackenzie Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260521000645 VA Practitioner - Nurse Practitioner 6305315169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1060 1St Colonial Rd
Virginia Beach, VA 23454

800 Independence Blvd
FL 5
Virginia Beach, VA 23455-6011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R256014MDMDAcute Care Nurse Practitioner
0024195196VAMDAcute Care Nurse Practitioner

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1753142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1265314280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 KATHRYN RD",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209042175",
            "telephone_number": "907-687-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-8667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1060 First Colonial Rd",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234543002",
            "country_code": "US",
            "telephone_number": "757-395-2323",
            "fax_number": "757-395-6280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "JENNIFER",
        "middle_name": "VENUS",
        "name_prefix": "Dr.",
        "credential": "AG-ACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-22",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R256014",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VA",
            "license": "0024195196",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MACKENZIE",
            "middle_name": "V",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.