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General NPI Number Information
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NPI Number | 1609728484
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS INTEGRATIVE PSYCHIATRY AND MEDICINE, PLLC
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 121 RUSSELL RD NW
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City | ABINGDON
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State | VA
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Zip | 24210-2758
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Country | US
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Telephone | 276-525-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 26669 NEWBANKS RD
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City | ABINGDON
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State | VA
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Zip | 24210-7592
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Country | US
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Telephone | 276-525-0031
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MIRANDA MARTIN HUCKS
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Credential | APRN
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Telephone | 276-525-0031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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