Provider Demographics
NPI:1710992391
Name:MCLEOD, REGINA CAROL (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:CAROL
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 HIGHWAY 1241
Mailing Address - Street 2:
Mailing Address - City:DRY PRONG
Mailing Address - State:LA
Mailing Address - Zip Code:71423-3635
Mailing Address - Country:US
Mailing Address - Phone:318-641-9021
Mailing Address - Fax:
Practice Address - Street 1:401 RAINBOW DR UNIT 35
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6979
Practice Address - Country:US
Practice Address - Phone:318-487-5191
Practice Address - Fax:318-487-5184
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN098486163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG9759OtherBLUECROSSBLUESHIELD
LA5DL60Medicare PIN