MEDICARE: MRS. MICHELE FONTENELLE MCLEOD N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R645982	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	640617252002	OTHER	MS	TRICARE
3	R645982	OTHER	MS	STATE LICENSE

General Provider Information

NPI Number	:	1346261864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE FONTENELLE MCLEOD N.P.

Provider Business Mailing Address
First Line	:	1211 BEXLEY CHURCH RD
Second Line	:
City	:	LUCEDALE
State	:	MS
Zip	:	39452-4643
Country	:	US
Telephone Number	:	601-947-7334
Fax Number	:	228-396-1835

Provider Business Practice Location Address
First Line	:	967 CEDAR LAKE RD STE B
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39532-2128
Country	:	US
Telephone Number	:	228-396-8531
Fax Number	:	228-396-1835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/07/2023

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Directions to “ MRS. MICHELE FONTENELLE MCLEOD N.P.” Practice Location

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