Healthcare Provider Details

I. General information

NPI: 1568697563
Provider Name (Legal Business Name): CRYSTAL ARDOIN FONTENOT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
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: 337-439-9250
Mailing address:
  • Phone: 337-651-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN103946-AP05780
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: