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NPI Code Detail

MEDICARE: CARSON ELIZABETH SHETLEY PA-C

MEDICARE: CARSON ELIZABETH SHETLEY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA07206TX
2363A00000XPhysician AssistantPA200181LA

General Provider Information

NPI Number : 1033390398
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARSON ELIZABETH SHETLEY PA-C
Provider Business Mailing Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Provider Business Practice Location Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2007
Last Update Date : 01/07/2025

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Directions to “ CARSON ELIZABETH SHETLEY PA-C” Practice Location

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