1841538030 NPI number — AMBER RILEY FONTAN CNP

Table of content: AMBER RILEY FONTAN CNP (NPI 1841538030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841538030 NPI number — AMBER RILEY FONTAN CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTAN
Provider First Name:
AMBER
Provider Middle Name:
RILEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RILEY
Provider Other First Name:
AMBER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841538030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10330 ROAD 375
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39350-3249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-656-0226
Provider Business Mailing Address Fax Number:
844-816-5716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10330 ROAD 375
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39350-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-656-0226
Provider Business Practice Location Address Fax Number:
601-389-6759
Provider Enumeration Date:
01/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R877207 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00050524 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".