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 1:903 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2754
Mailing Address - Country:US
Mailing Address - Phone:985-974-9476
Mailing Address - Fax:
Practice Address - Street 1:903 W OAK ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2754
Practice Address - Country:US
Practice Address - Phone:985-323-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily