Provider Demographics
NPI:1629777966
Name:PHENOMENAL HEALTH CARE, PLLC
Entity Type:Organization
Organization Name:PHENOMENAL HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FUCHSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-489-2570
Mailing Address - Street 1:2129 FM 2920
Mailing Address - Street 2:STE 190 #210
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388
Mailing Address - Country:US
Mailing Address - Phone:713-489-2570
Mailing Address - Fax:
Practice Address - Street 1:17030 NANES DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2504
Practice Address - Country:US
Practice Address - Phone:713-489-2570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Multi-Specialty