Deer Lake Lodge, LLC
NPI 1922769231ActiveOrganization· Nutritionist· Montgomery, TX
Nutritionist in Montgomery, Texas, registered in NPPES in January 2022. The authorized official on file is Tracy Boulware, Spa & Wellness Director.
Overview
| NPI | 1922769231 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 8, 2022 |
| Last updated in NPPES | Jan 8, 2022 |
| Certified by provider | Dec 21, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nutritionist Primary | 133N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|