MEDICARE: TIFFANY GABRIELLE OWENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		TX
2	172V00000X	Community Health Worker		TX

General Provider Information

NPI Number	:	1396615613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY GABRIELLE OWENS

Provider Business Mailing Address
First Line	:	616 FM 1960 RD W STE 528
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3024
Country	:	US
Telephone Number	:	346-892-1952
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 FM 1960 RD W STE 528
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3024
Country	:	US
Telephone Number	:	346-892-1952
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	02/16/2026

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Directions to “ TIFFANY GABRIELLE OWENS ” Practice Location

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