Provider Demographics
NPI:1083167779
Name:FONTENOT, KYRA (MHP)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W CHERRY ST
Mailing Address - Street 2:APT 9
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-4277
Mailing Address - Country:US
Mailing Address - Phone:337-662-3737
Mailing Address - Fax:
Practice Address - Street 1:810 W CHERRY ST
Practice Address - Street 2:APT 9
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-662-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor