Healthcare Provider Details

I. General information

NPI: 1285564427
Provider Name (Legal Business Name): FONTENOT MEDICAL & AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 VEROT SCHOOL RD STE B
LAFAYETTE LA
70508-5094
US

IV. Provider business mailing address

626 VEROT SCHOOL RD STE B
LAFAYETTE LA
70508-5094
US

V. Phone/Fax

Practice location:
  • Phone: 337-651-9120
  • Fax:
Mailing address:
  • Phone: 337-651-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDRE MORONNING
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-651-9120