Provider Demographics
NPI:1710584263
Name:SETLIFF, KAYCIE FONTENOT (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYCIE
Middle Name:FONTENOT
Last Name:SETLIFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYCIE
Other - Middle Name:NICOLE
Other - Last Name:FONTENOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1596 RIVERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-1823
Mailing Address - Country:US
Mailing Address - Phone:337-466-8272
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:866-624-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant