Provider Demographics
NPI:1245714302
Name:SLEDGE, REGINA LYNN (NP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:LYNN
Last Name:SLEDGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W 5TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5065
Mailing Address - Country:US
Mailing Address - Phone:432-640-3445
Mailing Address - Fax:
Practice Address - Street 1:540 W 5TH ST STE 330
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5065
Practice Address - Country:US
Practice Address - Phone:432-640-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142249363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101108000Medicaid