Provider Demographics
NPI:1154175701
Name:FONTENOT, LAQUANTA DEONDRIGUE (NP)
Entity type:Individual
Prefix:
First Name:LAQUANTA
Middle Name:DEONDRIGUE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:LAQUANTA
Other - Middle Name:DEONDRIGUE
Other - Last Name:FONTENOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:336 E RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-2710
Mailing Address - Country:US
Mailing Address - Phone:225-306-2060
Mailing Address - Fax:225-654-0758
Practice Address - Street 1:336 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2710
Practice Address - Country:US
Practice Address - Phone:225-306-2060
Practice Address - Fax:225-654-0758
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily