Provider Demographics
NPI:1427288422
Name:FONTENOT, JENNIFER P (DNP, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:FONTENOT
Suffix:
Gender:
Credentials:DNP, APRN, NP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:P
Other - Last Name:GRISHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6145 SHALLOWFORD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7808
Mailing Address - Country:US
Mailing Address - Phone:423-893-6890
Mailing Address - Fax:423-648-1115
Practice Address - Street 1:2440 JULIAN DR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5433
Practice Address - Country:US
Practice Address - Phone:423-250-5551
Practice Address - Fax:423-648-1115
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14281207RR0500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology