Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Nicolette Denee Shafto, PA

Individual provider Medical Physician Assistant · NPI 1417325218

Mrs. Nicolette Denee Shafto, PA is a Physician Assistant in Shreveport, Louisiana. Qualified in 2015, 11 years ago. Practices with Our Lady of the Lake Physician Group LLC, a 635-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
11
Licensed in
LA
In the registry since
2015
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1811 E Bert Kouns Industrial Loop Ste 210
Shreveport, LA 71105-5740
Phone: (318) 212-3858
Fax: (318) 212-3958
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7777 Hennessy Blvd Ste 1008, Baton Rouge, LA 70808-4368 — (225) 766-0416

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA.200885 (LA)

Record details

NPI number1417325218
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 10, 2015
Last updated in NPPESJune 24, 2026
Certification dateJune 24, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Our Lady Of The Lake Physician Group Llc — 635 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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