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SOUR LAKE HEALTH & MEDICAL
NPI 1346511433
Nurse Practitioner - Family in Sour Lake, TX

Active since January 20, 2012CLIA 45D2040635 · Waiver
689 SIXTH STREET, SOUR LAKE, TX 77659(409) 287-4100(409) 287-4105 Get Directions Write a Review

NPPES record last updated: March 27, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Sour Lake Health & Medical NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUR LAKE HEALTH & MEDICAL (NPI 1346511433) is a healthcare organization registered as a family in Sour Lake, Texas and active in the NPI registry since January 2012. The organization holds a CLIA Waiver certificate valid through May 6, 2028 and lists Lacey Guedry, Owner, as its authorized official.

NPPES Registry Identity

NPI1346511433
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameSOUR LAKE HEALTH & MEDICAL, PLLC
Location Address689 SIXTH STREETSour Lake, TX 77659-1870
Mailing AddressPo Box 429Sour Lake, TX 77659-0429 · (409) 287-4100 · Fax (409) 287-4105
Phone(409) 287-4100
Fax(409) 287-4105
Organization SubpartNo
Authorized OfficialLacey GuedryOwner · (409) 287-4100
Enumeration DateJanuary 20, 2012
Last NPPES UpdateMarch 27, 2019
✔ NPI 1346511433 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in TX · 712554
689 SIXTH STREET, Sour Lake, TX 77659
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Other Names 1

Doing Business AsSour Lake Health & Medical

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2040635

Sour Lake Health & Medical · Sour Lake, TX
Active · expires May 6, 2028
CLIA Number45D2040635
Laboratory TypePractitioner Other
Certificate Effective DateMay 7, 2026
Certificate Expiration DateMay 6, 2028
Laboratory DirectorLacey Guedry
Laboratory Phone(409) 287-4100
Laboratory LocationSour Lake Health & Medical689 Sixth St, Sour Lake, TX 77659
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sour Lake Health & Medical, PLLC's NPI number?

The NPI number for Sour Lake Health & Medical, PLLC is 1346511433. It was assigned to this organization in the NPPES registry on January 20, 2012. The provider is doing business as Sour Lake Health & Medical.

Where is Sour Lake Health & Medical, PLLC located?

Sour Lake Health & Medical, PLLC is located at 689 Sixth Street, Sour Lake, TX 77659. The listed phone number is (409) 287-4100.

What is Sour Lake Health & Medical, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Sour Lake Health & Medical, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2040635) is associated with this NPI, valid through May 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Sour Lake Health & Medical, PLLC was last updated on March 27, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.