Provider Demographics
NPI:1790968832
Name:FONTENOT, BRITNEY FOXWORTH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:FOXWORTH
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 VIDRINE RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-8780
Mailing Address - Country:US
Mailing Address - Phone:337-506-3500
Mailing Address - Fax:
Practice Address - Street 1:4940 VIDRINE RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-2976
Practice Address - Country:US
Practice Address - Phone:337-506-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200165363AM0700X
LAPA200165363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1026671Medicaid
LA1026671Medicaid