Provider Demographics
NPI:1578285540
Name:LAKEHILL PREPARATORY SCHOOL: HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:LAKEHILL PREPARATORY SCHOOL: HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AND WELLNESS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:214-826-2931
Mailing Address - Street 1:2720 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3429
Mailing Address - Country:US
Mailing Address - Phone:214-826-2931
Mailing Address - Fax:
Practice Address - Street 1:2720 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3429
Practice Address - Country:US
Practice Address - Phone:214-826-2931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health