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Individual

CARA GRADNEY FONTENOT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2370 GAUSE BLVD E, SLIDELL, LA 70461-4141
(985) 639-3755
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
49863
TN
208000000X
Pediatrics Physician
Primary
MD.206847
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05802213
MS
05
2371321
LA
Enumeration date
06/21/2010
Last updated
11/21/2014
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