Jack Allen Lafountain, RN
Individual provider Active NPI Registered Nurse · Parker, AZ
NPI 1710239181 · NPPES record last updated Oct 10, 2012
Key facts
- NPI
- 1710239181
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 00580 (OK)
- Practice address
- 12033 Agency Rd
Parker, AZ 85344-7718 - Phone
- (580) 451-0202
- NPI assigned
- Oct 10, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00580 | OK | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 00580 | OK | Yes |
Addresses
Primary practice location
12033 Agency Rd
Parker, AZ 85344-7718
Mailing address
PO Box 492
Tipton, OK 73570-0492
Phone (580) 451-0202
Other providers in Parker, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.