Provider Demographics
NPI:1770569931
Name:FONTENOTE, PAULA KAY (ANP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:FONTENOTE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAY
Other - Last Name:SCHECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:401 FOCH ST APT 1436
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2598
Mailing Address - Country:US
Mailing Address - Phone:501-463-0876
Mailing Address - Fax:
Practice Address - Street 1:401 FOCH ST APT 1436
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2598
Practice Address - Country:US
Practice Address - Phone:501-463-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9394822363LF0000X, 363LA2100X
ARA01887ANP363L00000X
TXAP121717363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178397758Medicaid
AR178397758Medicaid