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Pamela Kinder Fountain

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140

PECOS Enrollment

This provider is enrolled in PECOS as PAMELA FOUNTAIN.

Based on the most recent information from CMS, provider Pamela Kinder Fountain is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1194955757
Provider Type
Individual
Full Name
Fountain, Pamela Kinder
Title
Ms.
Credential
MSN, RNC, APRN-BC

Gender
Female
Sole Proprietor
No
Enumeration Date
7/16/2009
Last Updated
3/11/2013

Contact Information

Practice Location

7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140

(260) 434-7088

(260) 435-7394

Mailing Location

7916 W Jefferson Blvd, Fort Wayne, IN 46804-4140

(260) 434-6377

(260) 434-6389

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License #71001329A Indiana
Code 363LG0600X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License #71001329A Indiana
Code 163WP0808X	Description Registered Nurse Nursing Service Providers	License 28108484A Indiana

Provider Identifiers

ID	Description	Issuer
ID 201006320	Description Medicaid	Issuer Unlisted Indiana

Pamela Kinder Fountain

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Becktell, Leia A.

Howard, Amy M

Zuber, Adam J.

Davis, Kelly

Heath, Melanie J.

Brown, Justin D.

Parra, Michelle Ann

Powell, Jana K.

Hoover, Kara Rae

Hermes, Tina J