Provider Demographics
NPI:1043546914
Name:FONTENOT, CHRISTINE LYNN (CSA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7310
Mailing Address - Country:US
Mailing Address - Phone:713-572-0030
Mailing Address - Fax:
Practice Address - Street 1:4126 SOUTHWEST FWY
Practice Address - Street 2:SUITE 800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7310
Practice Address - Country:US
Practice Address - Phone:713-572-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3159363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical