Individual
ANDREW FONTENOT SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-8699
(901) 545-8996
Mailing address
1407 UNION AVE STE 640, MEMPHIS, TN 38104-3666
(901) 866-8360
(901) 302-2360
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
17580
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02636357
—
MS
05
—
197571001
—
AR
05
—
Q002094
—
TN
Enumeration date
03/18/2013
Last updated
08/11/2014
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