Healthcare Provider Details

I. General information

NPI: 1760360218
Provider Name (Legal Business Name): AMBER FOUNTAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 ACTON RD
VESTAVIA AL
35243-2502
US

IV. Provider business mailing address

2475 CHAPEL LAKES LN APT C
WETUMPKA AL
36092-5814
US

V. Phone/Fax

Practice location:
  • Phone: 205-332-3160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1176883
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: