Provider Demographics
NPI:1801460555
Name:FOUNDATION HEALTHCARE PLLC
Entity type:Organization
Organization Name:FOUNDATION HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BEARDEN YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-C
Authorized Official - Phone:832-539-8898
Mailing Address - Street 1:7109 FM 2920 RD STE 600
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2218
Mailing Address - Country:US
Mailing Address - Phone:832-539-8898
Mailing Address - Fax:866-638-5742
Practice Address - Street 1:7109 FM 2920 RD STE 600
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2218
Practice Address - Country:US
Practice Address - Phone:832-539-8898
Practice Address - Fax:866-638-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX819885OtherMEDICARE