SOUR LAKE HEALTH & MEDICAL, PLLC (NPI# 1346511433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346511433 |
| Entity Type | Organization |
| Organization Name | SOUR LAKE HEALTH & MEDICAL, PLLC |
| Other Organization Name | SOUR LAKE HEALTH & MEDICAL |
| Practice Address |
689 Sixth Street Sour Lake TX 77659-1870 |
| Mailing Address |
Po Box 429 Sour Lake TX 77659-0429 |
| Practice Telephone | 4092874100 |
| Practice Fax Number | 4092874105 |
| Mailing Telephone | 4092874100 |
| Mailing Fax Number | 4092874105 |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2019-03-27 |
| Authorized Official Name | MRS. LACEY GUEDRY (OWNER) |
| Authorized Official Telephone | 4092874100 |
| Authorized Official Credential | MSN, APRN, FNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
712554 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Sour Lake Health & Medical | Doing Business As Name - Organization |
| Street Address |
689 SIXTH STREET |
| City | SOUR LAKE |
| State | TX |
| Zip Code | 77659-1870 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508033507 | Paul Wesolow | Family Medicine | 317 Hwy 326 South, Sour Lake, TX 77659 | 2008-05-09 |
| 1407977960 | Paul Wesolow Md | Family Medicine | 517 S Hwy 326, Sour Lake, TX 77659 | 2007-04-03 |
| 1306966197 | Shawn D Klinger | Specialist/Technologist | Highway 326, Sour Lake, TX 77659 | 2007-03-29 |
| 1811078827 | John H Shary IIi | Specialist | 8542 Wilkins Ranch Rd, Sour Lake, TX 77659 | 2006-10-17 |
| 1487756417 | Thomas C Perry | Emergency Medicine | 9971 Old Batson Saratoga Rd, Sour Lake, TX 77659 | 2006-09-01 |
| 1316915879 | Hardin County Emergency Service District No 5 | Ambulance | 711 6th St, Sour Lake, TX 77659 | 2006-03-10 |
| 1952566838 | Sommer Kolander Shackelford | Nurse Practitioner | 689 Sixth St., Sour Lake, TX 77659-1870 | 2008-07-21 |
| 1710349121 | Karla Michelle Kicak | Speech-Language Pathologist | 445 Elm St, Sour Lake, TX 77659-2837 | 2016-03-24 |
| 1114248705 | Senior Preferred Homecare LLC | Home Health | 111 S Merchant St, Sour Lake, TX 77659-2901 | 2010-06-17 |
| 1821449208 | Lacey Ann Guedry | Nurse Practitioner | 689 6th Street, Sour Lake, TX 77659-7765 | 2016-06-27 |
| Find all providers in zip 77659 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821449208 | Lacey Ann Guedry | Nurse Practitioner | 689 6th Street, Sour Lake, TX 77659-7765 | 2016-06-27 |
| 1952566838 | Sommer Kolander Shackelford | Nurse Practitioner | 689 Sixth St., Sour Lake, TX 77659-1870 | 2008-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255162 | Shaida Rahmatinick | Nurse Practitioner | 1515 W 22nd St, Houston, TX 77008-1501 | 2020-11-08 |
| 1891396586 | Stacey Lynne Ready | Nurse Practitioner | 200 Uptmore Rd, West, TX 76691-2339 | 2020-11-08 |
| 1992306609 | Jillian Mcclintock | Nurse Practitioner | 2506 Graystone Ln, Corinth, TX 76210-1607 | 2020-11-08 |
| 1851992515 | Stacie A Gregg | Nurse Practitioner | 1229 Johnny Ln, San Angelo, TX 76905-2331 | 2020-11-07 |
| 1285235929 | Activate Family Health, Pllc | Nurse Practitioner | 203 E Davis St Ste F-1026, Conroe, TX 77301-3159 | 2020-11-07 |
| 1629679782 | Kristen Aili Johnson | Nurse Practitioner | 3850 Fm 18, Abilene, TX 79602-2004 | 2020-11-05 |
| 1376144303 | Stephanie Renee Knight | Nurse Practitioner | 4326 Egret Dr, Seabrook, TX 77586-2557 | 2020-11-05 |
| 1457952319 | Olufunke Oyindamola Oshoba | Nurse Practitioner | 200 Odyssey Ln, Mansfield, TX 76063-3438 | 2020-11-05 |
| 1518568419 | Ian Mardis | Nurse Practitioner | 12528 Tierra Encino Dr, El Paso, TX 79938-4525 | 2020-11-05 |
| 1851992994 | Angela Davis | Nurse Practitioner | 9523 Scanlan Heights Ln, Missouri City, TX 77459-5503 | 2020-11-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.