Provider Demographics
NPI:1013228360
Name:FOUNTAIN, RHONDA L (NP-C)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:L
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-1200
Mailing Address - Country:US
Mailing Address - Phone:812-358-2400
Mailing Address - Fax:812-358-2446
Practice Address - Street 1:806 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-1200
Practice Address - Country:US
Practice Address - Phone:812-358-2400
Practice Address - Fax:812-358-2446
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003260A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily