OrganizationActive
Bloom Integrative Wellness Center of South Lake, LLC
NPI 1033831227 · Women's Health Nurse Practitioner · Dallas, TX
Provider details
- NPI number
- 1033831227
- Entity type
- Organization
- Primary specialty
- Women's Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Tiffany Reynolds, Ceo(931) 980-1911
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Ambulatory Family Planning Facility261QA0005X
Ambulatory Health Care Facilities
Profile Score
Established profile(60/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
14114 Dallas Pkwy Ste 310
Dallas, TX 75254-1315
Phone: (844) 864-8928
Street-level locationGet directions
Mailing address
539 W Commerce St # 4488
Dallas, TX 75208-1953
Other names (DBA / former)
- Doing business as
- Bloom Integrative Wellness Center
Registry dates
- Enumerated
- 2022-09-14
- Last updated
- 2026-01-27
- Certified
- 2026-01-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.