OrganizationActive
Jelissa Nicole
NPI 1639769862 · Prosthetic/Orthotic Supplier · Dallas, TX
Provider details
- NPI number
- 1639769862
- Entity type
- Organization
- Primary specialty
- Prosthetic/Orthotic SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Jelissa Bates, Owner(214) 497-8580
Specialties & taxonomies
Suppliers
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 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
18880 Marsh Ln Apt 1902
Dallas, TX 75287-2241
Phone: (214) 497-8580
Street-level locationGet directions
Mailing address
18880 Marsh Ln Apt 1902
Dallas, TX 75287-2241
Registry dates
- Enumerated
- 2021-01-21
- Last updated
- 2021-01-21
- Certified
- 2021-01-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.