Holtzclaw, Carson Shetley

Holtzclaw, Carson Shetley is an individual health care provider with primary practice located at 6841 Fern Ave Ste 100 , Shreveport LA 71105-4175. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Holtzclaw, Carson Shetley can be contacted via phone (318) 868-2273.

Contact Information

Primary practice address
6841 Fern Ave Ste 100 Shreveport LA 71105-4175
Phone: (318) 868-2273
Fax: (318) 868-4219
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA07206 Texas
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA200181 Louisiana

Profile Details

NPI number 1033390398
LBN Legal business name Holtzclaw, Carson Shetley
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2007
Last updated Jul 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033390398 NPPES
Louisiana MEDICAID 1157872

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