Individual provider Active NPI

Raegan Lauderdale

  • Certified Registered Nurse Anesthetist
  • Houston, TX
National Provider Identifier
1629693189
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
231973 Issued in AR
Practice address
2908 Rusk St
Houston, TX 77003-2901
Phone
(210) 219-5750
NPI assigned
Jun 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 957958 TX
Certified Registered Nurse Anesthetist 367500000X 231973 AR Primary

Addresses

Primary practice location

2908 Rusk St
Houston, TX 77003-2901

Mailing address

1155 Dairy Ashford Rd Ste 560
Houston, TX 77079-3035
Phone (713) 799-2200

Other practice location 1

4301 W Markham St # 515
Little Rock, AR 72205-7101
Phone (501) 686-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251216004212 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 2860987989 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Childrens Way
Little Rock, AR 72202-3500

4301 W Markam St
Little Rock, AR 72205-7101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
957958TXMDRegistered Nurse
231973ARMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Dec 15, 2025 Accepting new patients
Arkansas Childrens Professional Services Organization LLC CurrentSince Dec 31, 2025 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Dec 15, 2025 Accepting new patients

Locations

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

4301 W Markham St
#515
Little Rock, AR 72205
Phone (501) 603-1656

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1629693189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 DAIRY ASHFORD RD STE 560",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770793035",
            "telephone_number": "713-799-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 RUSK ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770032901",
            "telephone_number": "210-219-5750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 W Markham St # 515",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722057101",
            "country_code": "US",
            "telephone_number": "501-686-8000",
            "fax_number": "501-526-5148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAUDERDALE",
        "first_name": "RAEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-10",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "957958",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "231973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.