Provider Demographics
NPI:1962716258
Name:FONTENOT, ANNA THEVENOT (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:THEVENOT
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-4208
Mailing Address - Country:US
Mailing Address - Phone:337-363-5531
Mailing Address - Fax:337-363-5052
Practice Address - Street 1:1008 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4208
Practice Address - Country:US
Practice Address - Phone:337-363-5531
Practice Address - Fax:337-363-5052
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06138363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health