Provider Demographics
NPI:1619442951
Name:LAFOUNTAIN, LEAH CARTER (NP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:CARTER
Last Name:LAFOUNTAIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CLARK SUMMIT DR STE F201
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4205
Mailing Address - Country:US
Mailing Address - Phone:912-256-2311
Mailing Address - Fax:
Practice Address - Street 1:25 CLARK SUMMIT DR STE F201
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4205
Practice Address - Country:US
Practice Address - Phone:843-757-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235704363LP0808X
SC23367363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health