Vickie Rochelle Mack

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

P122165 Issued in MS

Practice address

811 Alvaredo St
Jackson, MS 39204-5317

Phone

(601) 372-8941

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Vickie Rochelle Mack Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1912088055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 ALVAREDO ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392045317",
            "telephone_number": "601-372-8941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 ALVAREDO ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392045317",
            "telephone_number": "601-372-8941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "VICKIE",
        "middle_name": "ROCHELLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MS",
            "license": "P122165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770172",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICKIE",
            "last_name": "MACK",
            "middle_name": "ROCHELLE",
            "prefix": "MS.",
            "credential": "LPN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alyson N. Mack, DO
• Andrea Mack
• James Edward Mack, PH.D.
• Linda Ruth Mack, NP
• Robin Lynn Mack, CANP
• Angela Nicole Macklin, LCSW
• Lydia Chase Macnealy, MD
• Yonette Macoon
• Abigail Hailee Macoy
• Carley Danielle Maddox

• Licensed Practical Nurse in Jackson, MS
• Providers in Jackson, MS by specialty
• Licensed Practical Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.