Nicolette Denee Shafto, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA.200885 Issued in LA

Practice address

1811 E Bert Kouns Industrial Loop Ste 210
Shreveport, LA 71105-5740

Phone

(318) 212-3858

Fax

(318) 212-3958

NPI assigned

Sep 10, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064
• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Congress Emergency Group LLC

  • Emergency Medicine Physician
  • Lafayette, LA
  • NPI 1912316944
  Medicare reassignment
• CVT Surgical Center, AMC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Baton Rouge, LA
  • NPI 1043252380
  Medicare reassignment
• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943
  Medicare reassignment
• Professional Emergency Physician Associates, LLC

  • Emergency Medicine Physician
  • Baton Rouge, LA
  • NPI 1992758247
  Medicare reassignment
• WK Pierremont Cardiology

  • Cardiovascular Disease Physician
  • Shreveport, LA
  • NPI 1235523002
  Medicare reassignment
• Our Lady of the Lake Physician Group LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Baton Rouge, LA
  • NPI 1235912502
  NPD
• Wash-St Tammany Reg Medical Center

  • General Acute Care Hospital
  • Bogalusa, LA
  • NPI 1508809088

  Physician Assistant

  NPD
• Our Lady of the Lake Physician Group LLC

  • Hematology & Oncology Physician
  • Baton Rouge, LA
  • NPI 1184671455

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Our Lady of the Lake Hospital Inc.

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782259200000",
    "number": "1417325218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIANA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-716-4908",
            "fax_number": "318-716-4854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 E BERT KOUNS INDUSTRIAL LOOP STE 210",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055740",
            "telephone_number": "318-212-3858",
            "fax_number": "318-212-3958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7777 Hennessy Blvd Ste 1008",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708084368",
            "country_code": "US",
            "telephone_number": "225-766-0416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFTO",
        "first_name": "NICOLETTE",
        "middle_name": "DENEE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-10",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PA.200885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "7777 Hennessy Blvd Ste 7000",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708080307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael Robert Sewell, MD
• Patrick E. Sewell Sr., M.D.
• Stephanie M Sexton
• Elizabeth Shackelford, M.A.
• Kywanna Shackelford, M.A.
• Shah Medical Group Apmc
• Mila D Shah-Bruce, M.D.
• Amber M Shah, M.D.
• Beejal Mukund Shah, PHARM.D.
• Hetvi Shah

• Medical Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.