NPI age
19 years
Enumerated 2006-11-01
● Active Type 2 · Organization
South Loop 12 Medical Clinic Llc
South Loop 12 Medical Clinic Llc is 1 of 22123 nurse practitioner organizations in Texas.
Primary specialty
Nurse Practitioner
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Nellum
Family Nurse Pactitione Certified
Last NPPES update
2014-10-09
Source: monthly bulk 2026-05
How this organization compares
Across 22123 active nurse practitioner providers in Texas.
NPI age
19 years
↑ 12 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2006 → 2026
2006-11Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
3232 Great Trinity Forest Way, Ste. 102
Dallas, TX 752167732
Mailing address
3232 Great Trinity Forest Way, Ste. 102
Dallas, TX 752167732
Authorized official
Connie Frances Nellum, MS, APRN-C
Family Nurse Pactitione Certified
📞 2143984157
Specialties
-
Nurse Practitioner PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 018919303 | |
| 01 (TX) | 5608640 | FIRST HEALTH PROVIDER ID |
| 01 (TX) | 7438197 | AETNA PROVIDER ID# |
| 01 (TX) | 8N8001 | BCBC PROVIDER ID# |
Practice context
Single-site organization. Only one practice location on file.
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Request a quote →How to verify this organization
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.