Portia L Fountain, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S2883 Issued in MS

Practice address

12007 Water Ridge Dr
Oxford, MS 38655-6015

Phone

(662) 801-8064

NPI assigned

Oct 13, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Safe at Home LLC

  • Occupational Therapist
  • Oxford, MS
  • NPI 1477171593
  Medicare reassignment NPD

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

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507852800000",
    "number": "1578074845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12007 WATER RIDGE DR",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386556015",
            "telephone_number": "662-801-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12007 WATER RIDGE DR",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386556015",
            "telephone_number": "662-801-8064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "PORTIA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-13",
        "last_updated": "2017-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S2883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corann Fondren, MSW
• Foot Doctor, PLLC
• Angela Arnold Forester, DPT
• Ben Phillips Fortner, BA, MS, JD
• Jamie Vice Fortner, FNP
• Ashley Nicole Fowler, BSW
• Brenda Lyle Fowler, D.D.S.
• Thomas D Fowlkes, M. D.
• Ariel Fox, BSW
• Cynthia Francis, MAC

• Speech-Language Pathologist in Oxford, MS
• Providers in Oxford, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.