Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

South Loop 12 Medical Clinic LLC

Organization Family Nurse Practitioner · NPI 1417034745

South Loop 12 Medical Clinic LLC is a Family Nurse Practitioner in Dallas, Texas. Licensed in Texas. Registered with an NPI since 2006.

Licensed in
TX
In the registry since
2006
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3232 Great Trinity Forest Way Ste 102
Dallas, TX 75216-7732
Phone: (214) 398-4157
Fax: (214) 398-4326
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 528675 (TX)

Record details

NPI number1417034745
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Connie Nellum — Family Nurse Pactitione Certified · (214) 398-4157
NPI enumeratedNovember 1, 2006
Last updated in NPPESOctober 9, 2014
Mailing address3232 Great Trinity Forest Way, Ste. 102, Dallas, TX 75216-7732

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