Provider Demographics
NPI:1508474131
Name:MICHAELA KING KLOSE APRN FNP BC PLLC
Entity Type:Organization
Organization Name:MICHAELA KING KLOSE APRN FNP BC PLLC
Other - Org Name:OPAL HEALTHCARE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN FNP BC, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP BC
Authorized Official - Phone:214-293-8180
Mailing Address - Street 1:9219 GARLAND RD STE 2107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4639
Mailing Address - Country:US
Mailing Address - Phone:214-293-8180
Mailing Address - Fax:
Practice Address - Street 1:9219 GARLAND RD STE 2107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4639
Practice Address - Country:US
Practice Address - Phone:214-293-8180
Practice Address - Fax:214-828-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty