Individual
MR. SENIA TIMOTHY FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP-C
Contact information
Practice address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
(337) 721-7237
Mailing address
501 DOCTOR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 312-8258
(337) 312-6711
Taxonomy
Speciality
Code
Description
License number
State
163WX0800X
Orthopedic Registered Nurse
RN117238
LA
363LA2200X
Adult Health Nurse Practitioner
Primary
AP06594
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2171381
—
LA
Enumeration date
04/29/2011
Last updated
03/21/2017
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