Provider Demographics
NPI:1366766388
Name:FONTENOT, KAYLA R (MD, OBGYN)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:R
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MD, OBGYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13757
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4028
Mailing Address - Country:US
Mailing Address - Phone:337-466-7246
Mailing Address - Fax:337-466-7247
Practice Address - Street 1:251 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535
Practice Address - Country:US
Practice Address - Phone:337-466-7246
Practice Address - Fax:337-466-7247
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD205158207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2106511Medicaid