Sour Lake Health & Medical, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

712554 Issued in TX

Legal business name

SOUR LAKE HEALTH & MEDICAL, PLLC

Doing business as

Sour Lake Health & Medical

Practice address

689 Sixth Street
Sour Lake, TX 77659-1870

Phone

(409) 287-4100

Fax

(409) 287-4105

NPI assigned

Jan 20, 2012

Last updated

Mar 27, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lacey Guedry, MSN, APRN, FNP-CNPI 1821449208

Title

Owner

Phone

(409) 287-4100

Specialties & licenses 1

Addresses

Other names 1

• Sour Lake Health & Medical Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lacey Ann Guedry, FNP-C

  • Family Nurse Practitioner
  • Sour Lake, TX
  • NPI 1821449208
  Medicare reassignment Care Compare group NPD Authorized official
• Patricia Ann Heirtzler, FNP-C

  • Nurse Practitioner
  • Sour Lake, TX
  • NPI 1043790785

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Sommer Kolander Shackelford, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Beaumont, TX
  • NPI 1952566838
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1346511433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 429",
            "city": "SOUR LAKE",
            "state": "TX",
            "postal_code": "776590429",
            "telephone_number": "409-287-4100",
            "fax_number": "409-287-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 SIXTH STREET",
            "city": "SOUR LAKE",
            "state": "TX",
            "postal_code": "776591870",
            "telephone_number": "409-287-4100",
            "fax_number": "409-287-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUR LAKE HEALTH & MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-20",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "GUEDRY",
        "authorized_official_first_name": "LACEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "409-287-4100",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSN, APRN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "712554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sour Lake Health & Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sour Lake Health & Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristine Matlock
• Paul Wesolow MD
• Thomas C Perry, M.D.
• Ciera Brooke Reeves, MS, LMFTA
• John H Shary III, MD
• James Eric Weldon, M.D.
• Julie Weldy
• Charles R Wilson, D.O.

• Family Nurse Practitioner in Sour Lake, TX
• Providers in Sour Lake, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.