Individual
JAKE FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1238 EDITH ST, OPELOUSAS, LA 70570
(337) 942-9292
(337) 942-9220
Mailing address
1238 EDITH ST, OPELOUSAS, LA 70570-5917
(337) 942-9292
(337) 942-9220
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
11/09/2017
Last updated
08/08/2018
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