=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831218650
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLA STAGG REID APRN PNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 6TH AVENUE
-----------------------------------------------------
City | KINDER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70648-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-738-4676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 6TH AVENUE
-----------------------------------------------------
City | KINDER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70648-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-738-4676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | AP06482/RN101079
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 686054
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | AP113376
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------