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General NPI Number Information
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NPI Number | 1427984137
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Entity Type | Individual
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Provider Name | JACQUELINE FOUNTAIN
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Gender | Female
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 2510 DORNOCH RD
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City | HENRICO
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State | VA
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Zip | 23294-5115
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Country | US
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Telephone | 804-970-8453
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 DORNOCH RD
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City | HENRICO
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State | VA
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Zip | 23294-5115
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Country | US
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Telephone | 804-970-8453
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Fax |
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 0001345991
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License Number State | VA
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