Ted Etell Fontenot, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AP06448 Issued in LA

Practice address

1717 Oak Park Blvd FL 2
Lake Charles, LA 70601-8990

Phone

(337) 494-3278

Fax

(337) 494-3240

NPI assigned

Jul 6, 2011

Last updated

Apr 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mr. Ted Etell Fontenot Former name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Charles Memorial Heart and Vascular CenterGroup PAC ID 4082689914, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060
• Beauregard Memorial Hospital Hospital, Deridder, LA, CCN 190050

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tfontenot5281969@direct.casso.us.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Charles Memorial Heart and Vascular Center

  dba Heart & Vascular Center

  • Cardiovascular Disease Physician
  • Lake Charles, LA
  • NPI 1407808405
  Medicare reassignment Care Compare group NPD
• Cardiovascular Specialists of Southwest Louisiana, LLC

  • Cardiovascular Disease Physician
  • Lake Charles, LA
  • NPI 1083711006
  NPD (past)
• Mulhearn Medical, LLC

  • Interventional Cardiology Physician
  • Lake Charles, LA
  • NPI 1184916371
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hospital Service District No 2 of Parish of Beauregard State of la

  dba Beauregard Memorial Hospital

  • Rural Acute Care Hospital
  • Deridder, LA
  • NPI 1831193499
  Care Compare affiliation
• Southwest Louisiana Hospital Association Inc

  dba Digestive Health Center of SWLA

  • Gastroenterology Physician
  • Lake Charles, LA
  • NPI 1285351411

  Hospital

  Care Compare affiliation
• Southwest Louisiana Hospital Association Inc

  dba Rheumatology Associates

  • Rheumatology Physician
  • Lake Charles, LA
  • NPI 1659424075

  Hospital

  Care Compare affiliation
• Southwest Louisiana Hospital Association Inc

  dba Lake Charles Memorial Hospital

  • General Acute Care Hospital
  • Lake Charles, LA
  • NPI 1972549855
  Care Compare affiliation

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1598052052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122152 DEPT 2152",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 OAK PARK BLVD FL 2",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018990",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Deridder",
            "state": "LA",
            "postal_code": "706344849",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "913 E Kent Dr",
            "address_purpose": "LOCATION",
            "city": "Sulphur",
            "state": "LA",
            "postal_code": "706635007",
            "country_code": "US",
            "telephone_number": "337-527-3610",
            "fax_number": "337-527-6063",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1322 Elton Rd Ste P",
            "address_purpose": "LOCATION",
            "city": "Jennings",
            "state": "LA",
            "postal_code": "705464100",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Dequincy",
            "state": "LA",
            "postal_code": "706333508",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONTENOT",
        "first_name": "TED",
        "middle_name": "ETELL",
        "name_prefix": "Mr.",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-06",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "LA",
            "license": "AP06448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2159445",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "AP06448",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TED",
            "last_name": "FONTENOT",
            "middle_name": "ETELL",
            "prefix": "MR.",
            "credential": "ANP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Reed A Fontenot Jr., MD
• Senia Timothy Fontenot, ANP-C
• Skyler Fontenot
• Stacy Nicole Fontenot, MS, CF-SLP
• Sydney Morales Fontenot, PMHNP-BC
• Thea Christine Fontenot, PA-C
• Footprints ABA Therapy LLC
• Keri Forbess-McCorquodale, MS, CEAP, LPC, LMFT
• Brian Paul Ford, M.D.
• Michael D Ford, CRNA

• Adult Health Nurse Practitioner in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Adult Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.