Bernice Fomunung

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP142982 Issued in TX

Practice address

375 SW 11TH St
Chehalis, WA 98532-4700

Phone

(564) 999-3410

Fax

(360) 740-3450

NPI assigned

Sep 30, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Texas Psychiatric Associates PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Denton, TX
  • NPI 1265628663
  NPD
• SK Innovative Brain Health PLLC

  • Psychiatry Physician
  • Frisco, TX
  • NPI 1174331664
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1225679368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3134 IZABELLA CT",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750338068",
            "telephone_number": "469-427-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 SW 11TH ST",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985324700",
            "telephone_number": "564-999-3410",
            "fax_number": "360-740-3450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMUNUNG",
        "first_name": "BERNICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-30",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP142982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Rene Finnell Townsend, LMHC
• Stephen R Fischer, PA-C
• Fitspa, LLC (The Well)
• Andrew James Flores
• Marina Sunset Flores
• Foot and Ankle Surgical Associates Inc PS
• Robert Marshall Ford, MD
• Robert Orland Ford, MD
• Dodi Forgione
• Ezra Joel Foss, NP-C

• Psychiatric/Mental Health Nurse Practitioner in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.