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BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
NPI 1033831227
Nurse Practitioner - Women's Health in Dallas, TX

Active since September 14, 2022CLIA 45D2286076 · Microscopy
14114 DALLAS PKWY STE 310, DALLAS, TX 75254(844) 864-8928 Get Directions Write a Review

NPPES record last updated: January 27, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 27, 2026, Oct 3, 2024, May 17, 2023 and 1 more (4 updates tracked since 2022).

About Bloom Integrative Wellness Center Of South Lake, Llc NPPES

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

BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC (NPI 1033831227), doing business as Bloom Integrative Wellness Center, is a healthcare organization registered as a women's health in Dallas, Texas and active in the NPI registry since September 2022. The organization holds a CLIA Microscopy certificate valid through July 23, 2027 and lists Tiffany Reynolds, Ceo, as its authorized official.

NPPES Registry Identity

NPI1033831227
Entity TypeOrganization
Primary Taxonomy363LW0102X
Legal Business NameBLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
Location Address14114 DALLAS PKWY STE 310Dallas, TX 75254-1315
Mailing Address539 W Commerce St # 4488Dallas, TX 75208-1953 · (844) 864-8928
Phone(844) 864-8928
Organization SubpartNo
Authorized OfficialTiffany ReynoldsCeo · (931) 980-1911
Enumeration DateSeptember 14, 2022
Last NPPES UpdateJanuary 27, 20264 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2026
✔ NPI 1033831227 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Women's HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LW0102X
Also ListedClinic/Center · Ambulatory Family Planning FacilityTaxonomy 261QA0005X
14114 DALLAS PKWY STE 310, Dallas, TX 75254
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Other Names 1

Doing Business AsBloom Integrative Wellness Center

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 45D2286076

Bloom Integrative Wellness Center · Dallas, TX
Active · expires Jul 23, 2027
CLIA Number45D2286076
Laboratory TypePractitioner Other
Certificate Effective DateJuly 24, 2025
Certificate Expiration DateJuly 23, 2027
Laboratory DirectorTiffany N. Reynolds
Laboratory Phone(844) 864-8928
Laboratory LocationBloom Integrative Wellness Center400 S Zang Blvd Ste 815, Dallas, TX 75208
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

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

JANEISHA S. MAYS
Nurse Practitioner (Family)
14114 DALLAS PKWY STE 310
DALLAS, TX 75254
Dallas County (945) 265-7963

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 Bloom Integrative Wellness Center Of South Lake, LLC's NPI number?

The NPI number for Bloom Integrative Wellness Center Of South Lake, LLC is 1033831227. It was assigned to this organization in the NPPES registry on September 14, 2022. The provider is doing business as Bloom Integrative Wellness Center.

Where is Bloom Integrative Wellness Center Of South Lake, LLC located?

Bloom Integrative Wellness Center Of South Lake, LLC is located at 14114 Dallas Pkwy Ste 310, Dallas, TX 75254. The listed phone number is (844) 864-8928.

What is Bloom Integrative Wellness Center Of South Lake, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.

Does Bloom Integrative Wellness Center Of South Lake, LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D2286076) is associated with this NPI, valid through July 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bloom Integrative Wellness Center Of South Lake, LLC was last updated on January 27, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.