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Organization
SOURCE FOUNTAIN WELLNESS LLC
Active
Organization
SOURCE FOUNTAIN WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVONNE ANUTATU NKEZE DNP, PMHNP - BC (OWNER)
(706) 589-6211
Entity
Organization
Contact information
Practice address
105 BANCROFT DR, FREDERICKSBURG, VA 22405-1206
(706) 589-6211
(450) 371-3016
Mailing address
105 BANCROFT DR, FREDERICKSBURG, VA 22405-1206
(706) 589-6211
(450) 371-3016
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/02/2026
Last updated
09/02/2026
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