Charles Edward Self, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA.A10425.RX Issued in LA

Practice address

1111 Homer Rd
Minden, LA 71055-3027

Phone

(318) 377-7500

Fax

(318) 377-2324

NPI assigned

Sep 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Minden Physician Practices LLC

  • Multi-Specialty Clinic/Center
  • Minden, LA
  • NPI 1497986764

  LA

  Medicare reassignment
• Minden Physician Practices LLC

  • Rural Health Clinic/Center
  • Haughton, LA
  • NPI 1699392589
  NPD
• Minden Physician Practices LLC

  • Rural Health Clinic/Center
  • Minden, LA
  • NPI 1720360795
  NPD
• Amazing Care, LLC

  • Primary Care Clinic/Center
  • Ruston, LA
  • NPI 1134438591
  NPD (past)
• Boersma Clinic, LLC

  • Family Medicine Physician
  • Ruston, LA
  • NPI 1104024686
  NPD (past)
• Louisiana Em-1 Medical Services, PC

  • Nurse Practitioner
  • Shreveport, LA
  • NPI 1265688667
  NPD (past)
• Texas Trail Emergency Physicians LLC

  • Emergency Medicine Physician
  • Shreveport, LA
  • NPI 1902052301
  NPD (past)

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1497741995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 GERMANTOWN RD",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710551301",
            "telephone_number": "318-469-6331",
            "fax_number": "318-377-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 HOMER RD",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710553027",
            "telephone_number": "318-377-7500",
            "fax_number": "318-377-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PA.A10425.RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA STATE PA LICENSE",
            "identifier": "PA.A10425.RX",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karin Nielsen Ryan, RPH
• Safe Passage Transportation LLC
• Scott J Aaron DC, a Professional Corporation
• Donna K. Scroggins, SLP
• Jazmaigne Sears
• Cheryl Lynne Shirley, LPC, LAC
• Pallavi Shirsat, MD
• Rachel B Shows, OD
• James William Sikes III, DDS
• Willie Simmons

• All providers in Minden, LA
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.