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General NPI Number Information
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NPI Number | 1194955757
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Entity Type | Individual
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Provider Name | PAMELA KINDER FOUNTAIN MSN, RNC, APRN-BC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 7950 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4140
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Country | US
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Telephone | 260-434-7088
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Fax | 260-435-7394
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Provider Business Mailing Address
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Address Line | 7916 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4140
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Country | US
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Telephone | 260-434-6377
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Fax | 260-434-6389
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | #71001329A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | #71001329A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 28108484A
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License Number State | IN
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