JELISSA NICOLE
Prosthetic/Orthotic Supplier

Address: 18880 Marsh Ln Apt 1902, Dallas, TX 75287-2241

JELISSA NICOLE (NPI# 1639769862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1639769862
Entity Type Organization
Organization Name JELISSA NICOLE
Practice Address 18880 Marsh Ln Apt 1902
Dallas
TX 75287-2241
Practice Telephone 2144978580
Mailing Address 18880 Marsh Ln Apt 1902
Dallas
TX 75287-2241
Mailing Telephone 2144978580
Certification Date 2021-01-21
Enumeration Date 2021-01-21
Last Update Date 2021-01-21
Authorized Official Telephone 2144978580
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification Taxonomy Group License Number License State Taxonomy Group
Y 335E00000X Prosthetic/Orthotic Supplier Suppliers

Associated Endpoints

Endpoint Type Endpoint Affiliation Affiliation Address Use Content
Other URL 2144978580 18880 Marsh Ln Apt 1902, Dallas, TX 752872241

Office Location

Street Address 18880 MARSH LN APT 1902
City DALLAS
State TX
Zip Code 75287-2241

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1740870005 Gifted Souls Mental Health Community Center LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 4341 Horizon Pkwy, 425, Dallas, TX 75287 2021-01-21
1356846307 Personal Health Assessment Internal Medicine · Clinical Cardiac Electrophysiology 18320 Michael Angelo Drive, Dallas, TX 75287 2018-03-29
1275051807 Vermelle Minor Prosthetist 4341 Horizon Pkwy 132, Dallas, TX 75287 2017-09-04
1831629625 Tumikee Perry Counselor · Professional 2903 Renaissance Circle, Dallas, TX 75287 2017-06-14
1326594177 Sweta Sheth Dds Dentist 18217 Midway Road #122, Dallas, TX 75287 2016-08-31
1003288259 Hamid Reza Pirnajmedin Specialist/Technologist, Other · Surgical Assistant 4808 Haverwood Ln Apt 1236, Dallas, TX 75287 2015-10-28
1013307313 Kaelee Rae Kail · Kaelee Rae Kendrick Occupational Therapist 17480 Dallas Pkwy # 400, Dallas, TX 75287 2015-01-26
1568875318 Nicole Carvacho Physical Therapist · Pediatrics 17480 North Dallas Tollway, Addison, TX 75287 2014-06-10
1326451873 Holly Davis Speech-Language Pathologist 17480 North Dallas Parkway, Suite 221, Dallas, TX 75287 2014-06-03
1033520077 Tammy Duran Non-emergency Medical Transport (VAN) 3653 Briargrove Lane, 1513, Dallas, TX 75287 2014-05-13
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Taxonomy Information

Taxonomy Code 335E00000X
Grouping Suppliers
Classification Prosthetic/Orthotic Supplier

Taxonomy Definition

An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1043820327 Ameristep Prosthetics Southwestern 5406 Harry Hines Blvd, Dallas, TX 75235-7211 2020-08-03
1912535121 Marvin Friedman 13601 Preston Rd Ste 205w, Dallas, TX 75240-4947 2020-04-01
1841780962 Ashley Ferguson 1811 Greenville Ave Ste 100, Dallas, TX 75206-7485 2018-05-14
1902307937 Myhair, LLC 1408 N Riverfront Blvd # 304, Dallas, TX 75207-3912 2018-02-25
1326585506 Tiffany Rodgers 6632 Mattney Dr, Dallas, TX 75237-2447 2017-01-25
1528469764 Baker O & P Enterprises, Inc. 1311 Record Crossing Rd, Dallas, TX 75235-6003 2014-09-08
1417244195 Scott Sabolich Prosthetic and Research LLC 15900 Preston Rd, Dallas, TX 75248-3551 2011-07-01
1215262373 Reliant Prosthetics 5481 Blair Rd Ste 100, Dallas, TX 75231-4101 2009-10-07
1760668552 O & P Designs, Inc. 10525 Newkirk St, Suite 260, Dallas, TX 75220-2330 2008-01-11
1134326614 Belt Line Medical Supply 7989 Belt Line Rd, Suite # 109, Dallas, TX 75248-5734 2007-06-28
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City DALLAS
Zip Code 75287

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.