Provider Demographics
NPI:1407859937
Name:KNAPP, ANDRE' FONTENOT (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ANDRE'
Middle Name:FONTENOT
Last Name:KNAPP
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-433-8400
Mailing Address - Fax:337-497-1173
Practice Address - Street 1:501 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5724
Practice Address - Country:US
Practice Address - Phone:337-433-8400
Practice Address - Fax:337-497-1173
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA87008-3457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00442150Medicare PIN
5X8217460Medicare PIN