Provider Demographics
NPI:1861699670
Name:FONTENOT, LINDA SUE GRIMME (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE GRIMME
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4003
Mailing Address - Country:US
Mailing Address - Phone:251-621-9440
Mailing Address - Fax:251-621-9687
Practice Address - Street 1:431 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4003
Practice Address - Country:US
Practice Address - Phone:251-621-9440
Practice Address - Fax:251-621-9687
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-024742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily