SUSAN J MACK RN, FNP
NPI 1396955316
Nurse Practitioner - Family in Flora, IL

Q: What is Susan Mack's NPI number?

The NPI number for Susan Mack is 1396955316. It was assigned to this individual provider in the NPPES registry on May 22, 2007.

Q: What is Susan Mack's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Susan Mack was last updated on May 6, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 22, 2007

929 STACY BURK DRIVE, FLORA, IL 62839(618) 662-2191 Get Directions Write a Review

NPPES record last updated: May 6, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Susan J Mack Rn, Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUSAN J MACK RN, FNP (NPI 1396955316) is an individual family provider in Flora, Illinois, licensed in Illinois (209007907) and active in the NPI registry since May 2007.

NPPES Registry Identity

NPI1396955316

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameSUSAN J MACKCredential: RN, FNP

Location Address929 STACY BURK DRIVEFlora, IL 62839

Mailing Address608 N Main StFlora, IL 62839-1406 · (618) 662-4246

Phone(618) 662-2191

Sole ProprietorNo

Enumeration DateMay 22, 2007

Last NPPES UpdateMay 6, 2016

✔ NPI 1396955316 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Licenses✔ Licensed in IL · 209007907✔ Licensed in MO · 070430

929 STACY BURK DRIVE, Flora, IL 62839

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Other Identifiers 2

Medicaid420123507MO

Medicare PIN785F631MO

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COUNTY OF CLAY

Pharmacy (Community/Retail Pharmacy)

929 STACY BURK DRIVE
FLORA, IL 62839

Clay County (618) 662-1600

DR. MICHAEL PAUL KLINGLER M.D.

Pediatrics

929 STACY BURK DRIVE
FLORA, IL 62839

Clay County (618) 662-2191

PONCIANO PORMENTIRA JR. DPT

Physical Therapist

929 STACY BURK DRIVE
FLORA, IL 62839

Clay County (618) 662-8060

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susan Mack's NPI number?

The NPI number for Susan Mack is 1396955316. It was assigned to this individual provider in the NPPES registry on May 22, 2007.

Where is Susan Mack located?

Susan Mack practices at 929 Stacy Burk Drive, Flora, IL 62839. The listed phone number is (618) 662-2191.

What is Susan Mack's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Susan Mack was last updated on May 6, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.