Provider Demographics
NPI:1730516162
Name:REYNOLDS, RANDALLA TAREN (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:RANDALLA
Middle Name:TAREN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:RANDALLA
Other - Middle Name:TAREN
Other - Last Name:CURRUTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:1000 WALTERS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4647
Mailing Address - Country:US
Mailing Address - Phone:337-480-8100
Mailing Address - Fax:
Practice Address - Street 1:1000 WALTERS ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4647
Practice Address - Country:US
Practice Address - Phone:337-480-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA021774OtherLOUISIANA STATE BOARD OF NURSING
LA2406728Medicaid
LAAP07476OtherAPRN LICENSE NUMBER
LA021774OtherLOUISIANA STATE BOARD OF NURSING