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Individual
AMY ALISE FONTENOT
Active
Individual
AMY ALISE FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-10507
NC
363A00000X
Physician Assistant
Primary
PA.310472
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-10507
NC BOARD STATE LICENSE
—
Enumeration date
08/01/2018
Last updated
08/04/2023
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