The Gallery of Dermatology and Advanced Aesthetics

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

THE GALLERY OF DERMATOLOGY AND ADVANCED AESTHETICS

Doing business as

The Gallery

Practice address

1936 Southwood Dr
Lake Charles, LA 70605-4131

Phone

(337) 564-7546

NPI assigned

Jul 14, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kerri Elizabeth Davis-Fontenot, MDNPI 1932528080

Title

Owner

Phone

(337) 564-7546

Specialties & licenses 1

Addresses

Other names 1

• The Gallery Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kerri Davis-Fontenot, MD

  • Dermatology Physician
  • Lake Charles, LA
  • NPI 1932528080
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1205408630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1936 SOUTHWOOD DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054131",
            "telephone_number": "337-564-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 SOUTHWOOD DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054131",
            "telephone_number": "337-564-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GALLERY OF DERMATOLOGY AND ADVANCED AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS-FONTENOT",
        "authorized_official_first_name": "KERRI",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-564-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Gallery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Dermatology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.