Individual
KEVIN JOHN FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4916 OVERTON PLZ, FORT WORTH, TX 76109
(817) 529-1144
(817) 334-0235
Mailing address
1043 FOX WOOD DR, KENNEDALE, TX 76060-6472
(817) 307-0459
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
651941
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP110669
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002422602
—
TX
Enumeration date
07/27/2006
Last updated
03/06/2024
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