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NPI Code Detail

MEDICARE: MELISSA MARIE FOUNTAIN PA-C

MEDICARE: MELISSA MARIE FOUNTAIN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA0004816CO

General Provider Information

NPI Number : 1609327493
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA MARIE FOUNTAIN PA-C
Provider Business Mailing Address
First Line : 1000 W SOUTH BOULDER RD STE 110
Second Line :
City : LAFAYETTE
State : CO
Zip : 80026-2753
Country : US
Telephone Number : 303-415-4355
Fax Number :
Provider Business Practice Location Address
First Line : 1000 W SOUTH BOULDER RD STE 110
Second Line :
City : LAFAYETTE
State : CO
Zip : 80026-2753
Country : US
Telephone Number : 303-415-4355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2016
Last Update Date : 01/23/2025

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Directions to “ MELISSA MARIE FOUNTAIN PA-C” Practice Location

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