Healthcare Provider Details

I. General information

NPI: 1831218650
Provider Name (Legal Business Name): CHARLA STAGG REID APRN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 6TH AVENUE
KINDER LA
70648-3519
US

IV. Provider business mailing address

108 6TH AVENUE
KINDER LA
70648-3519
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-4676
  • Fax:
Mailing address:
  • Phone: 337-738-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP06482/RN101079
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number686054
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP113376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: