Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Fountain, MD

Individual provider Diagnostic Radiology Physician · NPI 1700016359

Kelly Fountain, MD is a Diagnostic Radiology in Melbourne, Florida. Graduated from University of South Alabama College of Medicine in 2009, 17 years ago. Practices with Lutheran Hospital Association of the San Luis Valley, a 150-clinician group and accepts Medicare assignment. Licensed in Alabama, Colorado, Florida and Kansas and 1 more.

Years since qualifying
17
Trained at
University of South Alabama College of Medicine
Licensed in
AL, CO, FL, KS, MS
In the registry since
2009
Specialties on file
5
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1223 Gateway Dr
Melbourne, FL 32901-2607
Phone: (321) 728-6002
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence ME 129581 (FL)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 23930 (MS)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 30719 (AL)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence DR.0057830 (CO)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 04-37158 (KS)

Record details

NPI number1700016359
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedJuly 16, 2009
Last updated in NPPESMay 10, 2020
Certification dateMay 10, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Also practisesNUCLEAR MEDICINE
Medical schoolUNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Graduated 2009 (17 years in practice)
Group practice Lutheran Hospital Association Of The San Luis Valley — 150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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