Individual
JACK ALLEN LAFOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
12033 AGENCY RD, PARKER, AZ 85344-7718
(580) 451-0202
Mailing address
PO BOX 492, TIPTON, OK 73570-0492
(580) 451-0202
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
00580
OK
Other
Enumeration date
10/10/2012
Last updated
10/10/2012
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