# SOURCE FOUNTAIN WELLNESS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750290110
- **Authorized official:** YVONNE ANUTATU NKEZE DNP, PMHNP - BC (OWNER)
- **Authorized official phone:** (706) 589-6211

## Contact information

- **Practice address:** 105 BANCROFT DR, FREDERICKSBURG, VA 22405-1206
- **Practice address phone:** (706) 589-6211
- **Practice address fax:** (450) 371-3016
- **Mailing address:** 105 BANCROFT DR, FREDERICKSBURG, VA 22405-1206
- **Mailing address phone:** (706) 589-6211
- **Mailing address fax:** (450) 371-3016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/02/2026
- **Last updated:** 09/02/2026