Healthcare Provider Details

I. General information

NPI: 1841466158
Provider Name (Legal Business Name): JACQUELINE LALL MICHAEL PHD, APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W COLORADO BLVD
DALLAS TX
75208
US

IV. Provider business mailing address

122 W COLORADO BLVD
DALLAS TX
75208-2382
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-6700
  • Fax: 214-947-6701
Mailing address:
  • Phone: 214-947-6700
  • Fax: 214-947-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number544527
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number544527
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP104870
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: