Provider Demographics
NPI:1861606774
Name:FOWLER, KARA LYNN (LPC, RD/LD, CDE, LMT)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LYNN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LPC, RD/LD, CDE, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 S MAYS ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6746
Mailing Address - Country:US
Mailing Address - Phone:512-733-9570
Mailing Address - Fax:
Practice Address - Street 1:1106 S MAYS ST STE 110
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6746
Practice Address - Country:US
Practice Address - Phone:512-733-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06366133V00000X
TX65738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered