MEDICARE: JENNIFER P FONTENOT DNP, APRN, NP-C

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	207RR0500X	Rheumatology Physician	14281	TN
2	363LF0000X	Family Nurse Practitioner	14281	TN

General Provider Information

NPI Number	:	1427288422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER P FONTENOT DNP, APRN, NP-C

Provider Business Mailing Address
First Line	:	6145 SHALLOWFORD RD STE 102
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-7808
Country	:	US
Telephone Number	:	423-893-6890
Fax Number	:	423-648-1115

Provider Business Practice Location Address
First Line	:	2440 JULIAN DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-5433
Country	:	US
Telephone Number	:	423-250-5551
Fax Number	:	423-648-1115

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

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	04/08/2025

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