Provider Demographics
NPI:1831218650
Name:REID, CHARLA STAGG (APRN PNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLA
Middle Name:STAGG
Last Name:REID
Suffix:
Gender:F
Credentials:APRN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-3519
Mailing Address - Country:US
Mailing Address - Phone:337-738-4676
Mailing Address - Fax:
Practice Address - Street 1:108 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-3519
Practice Address - Country:US
Practice Address - Phone:337-738-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06482/RN101079363LP0200X
TX686054363LP0200X
TXAP113376363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2155971Medicaid