MEDICARE: MICHAELA KING KLOSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP129526	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	458409YNQJ	OTHER	TX	MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP129526	OTHER	TX	APRN TX LICENSE
2	F1015126	OTHER	TX	AANP CERTIFICATION NUMBER
3	2015005246	OTHER	TX	ANCC

General Provider Information

NPI Number	:	1528431178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA KING KLOSE

Provider Business Mailing Address
First Line	:	9219 GARLAND RD STE 2107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4639
Country	:	US
Telephone Number	:	972-664-4995
Fax Number	:	833-970-0961

Provider Business Practice Location Address
First Line	:	9219 GARLAND RD STE 2107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4639
Country	:	US
Telephone Number	:	972-664-4995
Fax Number	:	833-970-0961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	06/08/2026

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Directions to “ MICHAELA KING KLOSE ” Practice Location

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