MEDICARE: PAULA KAY FONTENOTE ANP

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	363LF0000X	Family Nurse Practitioner	ARNP9394822	FL
2	363L00000X	Nurse Practitioner	A01887ANP	AR
3	363LF0000X	Family Nurse Practitioner	AP121717	TX
4	363LA2100X	Acute Care Nurse Practitioner	ARNP9394822	FL
5	363LA2100X	Acute Care Nurse Practitioner	AP121717	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770569931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA KAY FONTENOTE ANP

Provider Business Mailing Address
First Line	:	401 FOCH ST APT 1436
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-2598
Country	:	US
Telephone Number	:	501-463-0876
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 FOCH ST APT 1436
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-2598
Country	:	US
Telephone Number	:	501-463-0876
Fax Number	:

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	05/20/2024

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