Individual
DYANNA MARIE FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5702 E CENTRAL TEXAS EXPY, KILLEEN, TX 76543-5500
(254) 680-7300
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T2603
TX
208D00000X
General Practice Physician
9924
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/07/2018
Last updated
08/10/2021
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