Jeffery Paul McCollum, CFNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R33523 Issued in NM

Practice address

9201 Montgomery Blvd NE
Albuquerque, NM 87111-2468

Phone

(505) 298-2505

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

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.

• After Hours Pediatrics PC

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

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1780740985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112468",
            "telephone_number": "505-298-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112468",
            "telephone_number": "505-298-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "JEFFERY",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "CNP-00693",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NM",
            "license": "R33523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70526338",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel McCloud, COTA/L
• James Mathew McClung
• Janice McClure, SLP
• Dane L. McClurg, DDS
• Maggie N McClymond, RN
• Kaylene Sharon McCollum, APRN-C
• Michael Shawn McCollum, LMSW
• Gabriele E McComas, DDS
• Shawn McConkey, PHARMD
• Melissa McConnell-Hand, LMHC

• 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 Apr 7, 2021; 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.