Provider Demographics
NPI:1366909186
Name:COLEMAN, TEESA FONTENOT (RN)
Entity type:Individual
Prefix:
First Name:TEESA
Middle Name:FONTENOT
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S SOILEAU ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5161
Mailing Address - Country:US
Mailing Address - Phone:337-789-6622
Mailing Address - Fax:
Practice Address - Street 1:308 W BLOCH ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5214
Practice Address - Country:US
Practice Address - Phone:337-948-0220
Practice Address - Fax:337-948-0324
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN107242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse