Individual
MS. PAMELA KINDER FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RNC, APRN-BC
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-7088
(260) 435-7394
Mailing address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-6377
(260) 434-6389
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
28108484A
IN
363LF0000X
Family Nurse Practitioner
Primary
#71001329A
IN
363LG0600X
Gerontology Nurse Practitioner
#71001329A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201006320
—
IN
Enumeration date
07/16/2009
Last updated
03/11/2013
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