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Lakeside Medical Wellness Clinic

Clinic/Center in Sulphur, LA · enumerated 2011 · authorized official Stacy Kirkum, Administrator.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1407147234

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Registry record

Entity type Organization (Type 2)
Legal business name Lakeside Medical Wellness Clinic
Practice address 1908 Maplewood Dr, Suite B, Sulphur, LA, 70663
Phone (337) 625-5050
Fax (337) 625-6726
Enumeration date Apr 27, 2011
Last updated in NPPES Apr 27, 2011

Taxonomy & classification

261Q00000X Clinic/Center Ambulatory Health Care Facilities · License MD14484R (LA) Primary

Authorized official

Name Stacy Kirkum
Title Administrator
Phone (337) 625-5050

Other identifiers

Identifier Type State Issuer
1476269 Medicaid LA -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Lakeside Medical Wellness Clinic?
The NPI for Lakeside Medical Wellness Clinic is 1407147234, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Lakeside Medical Wellness Clinic?
NPPES lists Stacy Kirkum (Administrator) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2011-04-27.