BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
NPI 1033831227
Nurse Practitioner - Women's Health in Dallas, TX
NPI Status: Active since September 14, 2022
Contact Information
14114 DALLAS PKWY STE 310
DALLAS, TX
ZIP 75254
Phone: (844) 864-8928
- Organization
- Nurse Practitioner
- Women's Health
- CLIA Number: 45D2286076
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 07-23-2027
About BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
This page provides the complete NPI Profile along with additional information for Bloom Integrative Wellness Center Of South Lake, Llc, a provider established in Dallas, Texas operating as a Nurse Practitioner, focusing in women's health . The healthcare provider is registered in the NPI registry with number 1033831227 assigned on September 2022. The practitioner's primary taxonomy code is 363LW0102X. The provider is registered as an organization and their NPI record was last updated January 2026. The provider's
- NPI
- 1033831227
- Provider Legal Name
- BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 14114 DALLAS PKWY STE 310 DALLAS, TX 75254
- Location Phone
- (844) 864-8928
- Mailing Address
- 539 W COMMERCE ST # 4488 DALLAS, TX 75208
- Mailing Phone
- (844) 864-8928
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-14-2022
- Last Update Date
- 01-27-2026
- Code Navigator
A nurse practitioner (NP) like Bloom Integrative Wellness Center Of South Lake, Llc is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner Women's Health
- Taxonomy Code
- 363LW0102X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QA0005X | Ambulatory Health Care Facilities | Clinic/Center |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D2286076
- Facility Type
- Practitioner Other
- Certificate Effective Date
- July 24, 2025
- Certificate Expiration Date
- July 23, 2027
- Laboratory Director
- TIFFANY N. REYNOLDS
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Bloom Integrative Wellness Center Of South Lake, Llc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1033831227, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1033831227, enumerated as an "organization" on September 14, 2022.
The provider is located at 14114 DALLAS PKWY STE 310 DALLAS, TX 75254 and the phone number is (844) 864-8928.
Nurse Practitioner with taxonomy code 363LW0102X and a focus in Women's Health.
