Provider Demographics
NPI:1750142840
Name:FOURNIER, CARMEN CARRERA (LMT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CARRERA
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-2932
Mailing Address - Country:US
Mailing Address - Phone:254-338-5976
Mailing Address - Fax:
Practice Address - Street 1:2100 E STAN SCHLUETER LOOP STE J
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3808
Practice Address - Country:US
Practice Address - Phone:254-338-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT125178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist