| Doctor Name: | MRS. ANDRA J FONTAINE |
| NPI Number: | 1083890461 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | MO2001019721 |
| Business Practice Address: | 107 N Pine St Pittsburg, KS - 667624743 |
| Business Phone Number: | 6202327500 |
| Business Fax Number: | 6202327501 |
| Mailing Address: | Po Box 1628, PITTSBURG |
| State: | KS |
| Postal Code: | 667621628 |
| Phone Number: | 6202327500 |
| Fax Number: | 6202327501 |
| NPI Enumeration Date: | 01/15/2008 |
| NPI Last Update Date: | 08/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | MO2001019721 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |