MR. CHARLES EDWARD SELF (NPI# 1497741995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497741995 |
| Entity Type | Individual |
| Full Name | MR. CHARLES EDWARD SELF |
| Credential | PA-C |
| Practice Address |
1111 Homer Rd Minden LA 71055-3027 |
| Mailing Address |
1611 Germantown Rd Minden LA 71055-1301 |
| Practice Telephone | 3183777500 |
| Practice Fax Number | 3183772324 |
| Mailing Telephone | 3184696331 |
| Mailing Fax Number | 3183772324 |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA.A10425.RX | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | LA STATE PA LICENSE | PA.A10425.RX | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942415559 | Charles Bernard Self | Marriage & Family Therapist | 1 Lifeway Plz, Nashville, TN 37234-0166 | 2007-05-14 |
| Street Address |
1111 HOMER RD |
| City | MINDEN |
| State | LA |
| Zip Code | 71055-3027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740282490 | Mark Allen Cimino | Emergency Medicine | 1111 Homer Rd, Minden, LA 71055-3027 | 2005-08-12 |
| 1831641448 | Brenda Hawkins | Nurse Practitioner | 1111 Homer Rd, Minden, LA 71055-3027 | 2016-10-30 |
| 1528443249 | Angela Fussell | Nurse Practitioner | 1111 Homer Rd, Minden, LA 71055-3027 | 2015-07-23 |
| 1497931570 | Sandra Alexander Frith | Counselor | 1111 Homer Rd, Minden, LA 71055-3027 | 2008-01-18 |
| 1659566982 | Family Medicine Associates of Minden, LLC | Clinic/Center | 1111 Homer Rd, Minden, LA 71055-3027 | 2007-09-10 |
| 1699834473 | Minden Physician Practices, LLC | Family Medicine | 1111 Homer Rd, Minden, LA 71055-3027 | 2006-12-07 |
| 1487610879 | Robert Ray Brown | Nurse Practitioner | 1111 Homer Rd, Minden, LA 71055-3027 | 2006-04-25 |
| 1669441671 | Shannon Dawn Spigener | Emergency Medicine | 1111 Homer Rd, Minden, LA 71055-3027 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911339 | Walter Matheny II | Nurse Practitioner | 216 W Union Street Ste A Minden, Minden, LA 71055 | 2020-10-27 |
| 1194331579 | Minden Family Pharmacy LLC | Pharmacy | 120 Homer Rd, Minden, LA 71055 | 2020-09-21 |
| 1003469479 | Premier Family Clinic | Nurse Practitioner | 102 Office Park Dr., Minden, LA 71055 | 2019-07-24 |
| 1952803389 | Regina Flournoy | Case Manager/Care Coordinator | 561 Angi Rd, Minden, LA 71055 | 2018-03-01 |
| 1902322233 | New Concept Development Center | Clinic/Center | 15365 Hwy 80, Minden, LA 71055 | 2017-08-18 |
| 1396269304 | Tashalana Walker | Counselor | 601 Homer Rd., Minden, LA 71055 | 2017-08-01 |
| 1992227029 | Kathryn Anne Landreneau | Nurse Practitioner | 101 Murrell St Ste 2, Minden, LA 71055 | 2017-07-11 |
| 1639699937 | Shykiia Hawkins | Counselor | 409 Meadowview Drive, Minden, LA 71055 | 2017-06-27 |
| 1053851147 | Shatoria Moore | Case Manager/Care Coordinator | 305 Homer Rd, Minden, LA 71055 | 2017-03-08 |
| 1821547258 | Sheretha Harrison | Counselor | 1008 Brenda Cir, Minden, LA 71055 | 2016-09-27 |
| Find all providers in zip 71055 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245209527 | Webster Emergency Group LLC | Physician Assistant | 1 Medical Plaza Pl, Minden, LA 71055-3330 | 2006-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174120307 | Olivia Hockenjos | Physician Assistant | 1000 Chinaberry Dr Ste 1200, Bossier City, LA 71111-2463 | 2020-10-01 |
| 1053928622 | Kennedy Poole | Physician Assistant | 1643 Carter St Ste 1, Vidalia, LA 71373-3157 | 2020-09-28 |
| 1699382176 | Morgan Prejean | Physician Assistant | 11445 Coursey Blvd Ste L, Baton Rouge, LA 70816-0411 | 2020-09-28 |
| 1972118776 | Emma W Bollich | Physician Assistant | 6703 Ambassador Caffery Pkwy Ste 2, Broussard, LA 70518-5283 | 2020-09-09 |
| 1316595937 | Antonia Colombo | Physician Assistant | 2705 Fable St, Meraux, LA 70075-2372 | 2019-08-27 |
| 1861058752 | Christina Daigle | Physician Assistant | 1057 Paul Maillard Rd Ste 2210, Luling, LA 70070-4349 | 2019-05-15 |
| 1376078022 | Brian Ammon | Physician Assistant | 11831 Oakwilde Ave, Baton Rouge, LA 70810-3120 | 2017-05-01 |
| 1912448036 | Christy Stoltz | Physician Assistant | 120 N Pinaud St, Saint Martinville, LA 70582-4732 | 2017-03-09 |
| 1790228013 | Brian Keith Fontenot | Physician Assistant | 2751 Albert L Bicknell Dr Ste 5c, Shreveport, LA 71103-3943 | 2016-11-18 |
| 1932658002 | Taylor Christensen Mahtook | Physician Assistant | 4650 Ambassador Caffery Pkwy Ste 101, Lafayette, LA 70508-6926 | 2016-09-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.