Mary K Fouquier, PHD, RN, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

25784 Issued in TN

Practice address

1207 N West St
Jackson, MS 39202-2018

Phone

(601) 354-6654

Fax

(601) 354-6289

NPI assigned

Feb 2, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Doctor of Philosophy, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1396017646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 N WEST ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022018",
            "telephone_number": "601-354-6654",
            "fax_number": "601-354-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 N WEST ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022018",
            "telephone_number": "601-354-6654",
            "fax_number": "601-354-6289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUQUIER",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "PHD, RN, CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-02",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "TN",
            "license": "25784",
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "MS",
            "license": "R887487",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03285886",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Reynolds Foster, OT
• Marylin Janet Fouche, M.D.
• Fountain of Youth Rehab, PLLC
• Candice Fountain
• Sarah Kay Fountain
• Four Corners Psychiatry PLLC
• Amanda Horne Fowler, M.D.
• Brooke Carolyn Fowler, MD
• Cecilia D Fowler, OT
• Gayla Fowler

• Advanced Practice Midwife in Jackson, MS
• Providers in Jackson, MS by specialty
• Advanced Practice Midwife in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.