Individual
MS. THEA CHRISTINE FONTENOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3830
Mailing address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3038
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
324688
LA
363AS0400X
Surgical Physician Assistant
324688
LA
Other
Enumeration date
10/14/2020
Last updated
09/26/2023
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