Provider Demographics
NPI:1821449208
Name:GUEDRY, LACEY ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:GUEDRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:SOUR LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:77659-0429
Mailing Address - Country:US
Mailing Address - Phone:409-287-4100
Mailing Address - Fax:409-287-4105
Practice Address - Street 1:689 6TH STREET
Practice Address - Street 2:
Practice Address - City:SOUR LAKE
Practice Address - State:TX
Practice Address - Zip Code:77659-7765
Practice Address - Country:US
Practice Address - Phone:409-287-4100
Practice Address - Fax:409-287-4105
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily