Provider Demographics
NPI:1730973850
Name:FONTENOT, DEIRDRE FAYE
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:FAYE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 E ADMIRAL DOYLE DR
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-6401
Mailing Address - Country:US
Mailing Address - Phone:337-579-8349
Mailing Address - Fax:337-579-8349
Practice Address - Street 1:5207 E ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-6401
Practice Address - Country:US
Practice Address - Phone:337-579-8349
Practice Address - Fax:337-579-8349
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator