Individual
MR. MADISON LEE FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, AGNP-C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5020174
NC
363LA2200X
Adult Health Nurse Practitioner
Primary
5020174
NC
363LS0200X
School Nurse Practitioner
304292
NC
Other
Enumeration date
01/13/2023
Last updated
07/02/2024
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