GLORIOUS LATRIC WILSON-REYNOLDS CPNP
NPI 1376898320
Nurse Practitioner - Pediatrics in La Porte, IN

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LP0200X and a focus in Pediatrics.

Active since July 16, 2012PECOS Enrolled

1509 STATE ST, LA PORTE, IN 46350(219) 324-3431(219) 362-3802 Get Directions Write a Review

NPPES record last updated: September 28, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 28, 2020, Sep 16, 2020 (2 updates tracked since 2020).

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About Glorious Latric Wilson-reynolds Cpnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GLORIOUS LATRIC WILSON-REYNOLDS CPNP (NPI 1376898320) is an individual pediatrics provider in La Porte, Indiana, licensed in Indiana (71005286A) and active in the NPI registry since July 2012. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376898320

Entity TypeIndividualFemale

Primary Taxonomy363LP0200X

Provider Legal NameGLORIOUS LATRIC WILSON-REYNOLDSCredential: CPNP

Location Address1509 STATE STLa Porte, IN 46350-3115

Mailing Address2022 Kelle DrChesterton, IN 46304-8708 · (219) 326-2312 · Fax (219) 326-2584

Phone(219) 324-3431

Fax(219) 362-3802

Sole ProprietorNo

Enumeration DateJuly 16, 2012

Last NPPES UpdateSeptember 28, 20202 updates tracked since enumeration

NPPES CertifiedSeptember 28, 2020

✔ NPI 1376898320 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0200X

Licenses✔ Licensed in IN · 71005286A✔ Licensed in IL · 209008737

1509 STATE ST, La Porte, IN 46350

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Glorious Latric Wilson-reynolds Cpnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46350 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$94.22 typical visit price

range $16.93 – $132.22

Typical copayment $23.55 (range $4.23 – $33.05)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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