Gardner Mack, MSN, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1168410 Issued in TX

Practice address

333 West Loop N Ste 250
Houston, TX 77024-1751

Phone

(713) 690-1991

NPI assigned

Jul 8, 2024

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

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

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.

• Ruan Medical Group

  dba Texas Center For Lifestyle Medicine

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1407394844
  Medicare reassignment NPD

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1609612605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2423 HAVERHILL DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770083030",
            "telephone_number": "832-373-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 WEST LOOP N STE 250",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770241751",
            "telephone_number": "713-690-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "GARDNER",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1168410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly Shaw Mack, LBSW
• Breonna Mack
• David Ross Mack, M.D.
• Dmonica Leflore Mack, LMSW
• Evangeline Mack, R.PH.
• Jacqueline K Mack, LPC
• Kevin Mack, LPC
• Maria A Mack, P-MHNP
• Preston C Mack, D.C.
• Rachael R. Mack, RSA, CSA

• Family Nurse Practitioner in Houston, TX
• Providers in Houston, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.