Bloom Integrative Wellness Center of South Lake, LLC

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

Legal business name

BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC

Doing business as

Bloom Integrative Wellness Center

Practice address

14114 Dallas Pkwy Ste 310
Dallas, TX 75254-1315

Phone

(844) 864-8928

NPI assigned

Sep 14, 2022

Last updated

Jan 27, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tiffany Reynolds, WHNPNPI 1114583093

Title

Ceo

Phone

(931) 980-1911

Specialties & licenses 2

Addresses

Other names 1

• Bloom Integrative Wellness Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiffany Reynolds, NP

  • Women's Health Nurse Practitioner
  • Dallas, TX
  • NPI 1114583093
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769472000000",
    "number": "1033831227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 W COMMERCE ST # 4488",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752081953",
            "telephone_number": "844-864-8928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14114 DALLAS PKWY STE 310",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752541315",
            "telephone_number": "844-864-8928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-14",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-980-1911",
        "authorized_official_credential": "WHNP"
    },
    "taxonomies": [
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Integrative Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dorothy Linn Blome, M.N., CPNP
• Robert Bates Blomeyer II, D.D.S.
• Preston Howard Blomquist, MD
• Alexander Blonsky
• Blood and Marrow Transplant Services
• Bloom Speech and Language Therapy
• Christopher A. Bloom, MD
• Kristy Bloom, PT
• Staci Bloom, PH.D.
• Steven L Bloom, MD

• Women's Health Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Women's Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.