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General NPI Number Information
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NPI Number | 1467363283
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Entity Type | Individual
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Provider Name | JESSICA FOUNTAIN RN, BSN, CDCES
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 1301 BELLEVILLE AVE
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City | BREWTON
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State | AL
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Zip | 36426-1306
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Country | US
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Telephone | 251-809-8308
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Fax |
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Provider Business Mailing Address
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Address Line | 421 BELLEVILLE AVE
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City | BREWTON
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State | AL
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Zip | 36426-2046
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Country | US
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Telephone |
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 1-104443
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License Number State | AL
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