Provider Demographics
NPI:1306411186
Name:FOUNTAIN, CHARNIECE WILCOX (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:CHARNIECE
Middle Name:WILCOX
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:CHARNIECE
Other - Middle Name:TASHEE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CRNA
Mailing Address - Street 1:4440 CAHABA RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6832
Mailing Address - Country:US
Mailing Address - Phone:205-354-3374
Mailing Address - Fax:
Practice Address - Street 1:3690 GRANDVIEW PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3326
Practice Address - Country:US
Practice Address - Phone:205-971-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151543163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse