Lara Dupre Sudik, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Ganado, TX
NPI 1396336459 · NPPES record last updated Feb 1, 2021
Key facts
- NPI
- 1396336459
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1024878 (TX)
- Practice address
- 910 Huisache St
Ganado, TX 77962-8414 - Phone
- (361) 649-4674
- NPI assigned
- Feb 1, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1024878 | TX | MD | Family Nurse Practitioner |
Interoperability endpoints
- lara.sudik.1@1902.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1024878 | TX | Yes |
Addresses
Primary practice location
910 Huisache St
Ganado, TX 77962-8414
Mailing address
910 Huisache St
Ganado, TX 77962-8414
Phone (361) 649-4674
Other providers in Ganado, TX
- Jackson County Hospital District
- Jackson County Hospital District
- Ronald D. Kosanke
- Bruce A. Ramsey
- Anibal G Scuadroni Jr.
- Chelsey Dawn Taylor
- W Sam Williams Jr MD PA
- West Wharton County Hospital District
- Wilford Samuel Williams
All providers in Ganado, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.