Charla Stagg Reid, APRN PNP
Individual provider Active NPI Pediatric Nurse Practitioner · Kinder, LA
NPI 1831218650 · NPPES record last updated Feb 6, 2025
Key facts
- NPI
- 1831218650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- AP113376 (TX)
- Practice address
- 108 6TH Avenue
Kinder, LA 70648-3519 - Phone
- (337) 738-4676
- NPI assigned
- Mar 29, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230525002794 | TX | Practitioner - Nurse Practitioner | 8628434198 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP06482/RN101079 | LA | MD | Pediatric Nurse Practitioner |
| 686054 | TX | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Liberty County Hospital District No 1 | Current |
Accepting new patients | |
| Liberty County Hospital District No 1 | Current |
Accepting new patients | |
| Goodside Health Medical, PLLC | Past | Accepting new patients |
Locations
1353 N Travis St
Liberty, TX 77575
Phone (936) 336-7316
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | AP06482/RN101079 | LA | |
| Pediatric Nurse Practitioner | 363LP0200X | 686054 | TX | |
| Pediatric Nurse Practitioner | 363LP0200X | AP113376 | TX | Yes |
Addresses
Primary practice location
108 6TH Avenue
Kinder, LA 70648-3519
Mailing address
108 6TH Avenue
Kinder, LA 70648-3519
Phone (337) 738-4676
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2155971 | Medicaid | LA |
Other providers in Kinder, LA
- Pelican Healthcare System LLC
- Emily D Pelican
- Brittany Kelly Pitre
- Premise Health of Louisanna, Professional Medical Corporation
- Private Healthcare Facilities
- Donna Lynn Roberts
- Thomas Jay Roberts
- Carson Schniers
- Amy Doguet Simon
- Sincererx Hometown Pharmacy LLC
All providers in Kinder, LA · Pediatric Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.