Individual provider Active NPI

Lauren L Gaudette, FNP

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1417979444
Registry record updated Feb 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
222505 Issued in TX
Practice address
912 W 12TH St
Dallas, TX 75208-6005
Phone
(214) 946-6400
Fax
(214) 946-6402
NPI assigned
Jul 25, 2006
Last updated
Feb 6, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 222505 TX Primary

Addresses

Primary practice location

912 W 12TH St
Dallas, TX 75208-6005

Mailing address

308 County Road 5025
Nacogdoches, TX 75964-8727
Phone (936) 462-3847

Other identifiers 1

IdentifierTypeStateIssuer
P083N6712MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040614001243 TX Practitioner - Nurse Practitioner 7214911759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brown Family Health Center IncGroup PAC ID 8426003120, 3 clinicians

Practice addresses (Care Compare)

1407 E Main St
Nacogdoches, TX 75961-5369
Phone (936) 569-8240

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brown Family Health Center Inc CurrentSince Jan 20, 2020 Accepting new patients
Acs Primary Care Physicians Southwest, PA Family Past Accepting new patients
Utmb Faculty Group Practice Past Accepting new patients

Locations

1407 E Main St
Nacogdoches, TX 75961
Phone (936) 569-8240

Interoperability endpoints

  • Direct secure messaging: lauren.gaudette.1@13578.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202256000000",
    "number": "1417979444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 COUNTY ROAD 5025",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759648727",
            "telephone_number": "936-462-3847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 W 12TH ST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752086005",
            "telephone_number": "214-946-6400",
            "fax_number": "214-946-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUDETTE",
        "first_name": "LAUREN",
        "middle_name": "L",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2008-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "222505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P083N6712",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.