Healthcare Provider Details

I. General information

NPI: 1508467515
Provider Name (Legal Business Name): NATALIE NICOLE FONTENOT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 RICHLAND WEST CIR
WACO TX
76712-7919
US

IV. Provider business mailing address

8150 SPRINGWOOD DR # 150B
IRVING TX
75063-5810
US

V. Phone/Fax

Practice location:
  • Phone: 254-777-8008
  • Fax:
Mailing address:
  • Phone: 469-253-5834
  • Fax: 469-213-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1010243
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number791906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: