Provider Demographics
NPI:1295572774
Name:FONTENOT, RENEY REED (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RENEY
Middle Name:REED
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5857
Mailing Address - Country:US
Mailing Address - Phone:337-246-7325
Mailing Address - Fax:
Practice Address - Street 1:437 N MARKET ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5857
Practice Address - Country:US
Practice Address - Phone:337-246-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235945363LP0808X
LA122478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse