Provider Demographics
NPI:1528431178
Name:KLOSE, MICHAELA KING (APRN, FNP-BC, NP-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:KING
Last Name:KLOSE
Suffix:
Gender:F
Credentials:APRN, FNP-BC, NP-C
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:KING
Other - Last Name:KLOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC, NP-C
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:972-863-9910
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:972-863-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP129526OtherAPRN TX LICENSE
TXF1015126OtherAANP CERTIFICATION NUMBER
TX2015005246OtherANCC
TX458409YNQJOtherMEDICARE NUMBER