Healthcare Provider Details

I. General information

NPI: 1972414258
Provider Name (Legal Business Name): ALEXIS MARIE FONTENOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS MARIE BROWN

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

5207 E ADMIRAL DOYLE DR
JEANERETTE LA
70544-6401
US

V. Phone/Fax

Practice location:
  • Phone: 225-313-5763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN104863
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: