1255514402 NPI number — MRS. ELIZABETH ASHLEY FONTENOT HORNSBY MPT

Table of content: MRS. ELIZABETH ASHLEY FONTENOT HORNSBY MPT (NPI 1255514402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255514402 NPI number — MRS. ELIZABETH ASHLEY FONTENOT HORNSBY MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTENOT HORNSBY
Provider First Name:
ELIZABETH
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FONTENOT
Provider Other First Name:
E.
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255514402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70606-4015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-722-2997
Provider Business Mailing Address Fax Number:
337-270-2546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SOUTHWOOD DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-722-2997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2007

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: 225100000X , with the licence number:  07331 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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