SOUR LAKE HEALTH & MEDICAL PLLC NPI 1346511433

NPI Information

  • NPI: 1346511433
  • Provider Name: SOUR LAKE HEALTH & MEDICAL, PLLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • Doing Business As: SOUR LAKE HEALTH & MEDICAL
  • CLIA Number: 45D2040635
  • Address: 689 SIXTH STREET
    SOUR LAKE, TX
    ZIP 77659
  • Phone: (409) 287-4100

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NPI Details

SOUR LAKE HEALTH & MEDICAL, PLLC is a family nurse practitioner in Sour Lake, TX. SOUR LAKE HEALTH & MEDICAL, PLLC NPI is 1346511433. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Sour Lake Health & Medical.

The provider's business location address is:

689 SIXTH STREET
SOUR LAKE, TX
ZIP 77659-870
Phone: (409) 287-4100
Fax: (409) 287-4105

The provider's authorized official is Lacey Guedry .
The authorized official title is Owner and has the following contact phone number (409) 287-4100.

The CLIA number assigned to this NPI record is 45D2040635 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/20/2012 and was last updated on 3/27/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily712554TEXASYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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