MEDICARE: TEXOMA LACTATION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)

General Provider Information

NPI Number	:	1083572481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXOMA LACTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	2102 HAYES ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76309-3818
Country	:	US
Telephone Number	:	940-217-6108
Fax Number	:	844-972-1555

Provider Business Practice Location Address
First Line	:	2102 HAYES ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76309-3818
Country	:	US
Telephone Number	:	940-217-6108
Fax Number	:	844-972-1555

Authorized Official
Title or Position	:	OWNER
Name	:	WILLI PATRICE GUTIERREZ
Credential	:	RN, BSN, IBCLC
Telephone Number	:	940-217-6108

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/20/2026

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