MEDICARE: TEARA FOWLER

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	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1841136454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEARA FOWLER

Provider Business Mailing Address
First Line	:	6742 FIRE HILL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 BANDIT TRL
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0111
Country	:	US
Telephone Number	:	817-646-7572
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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Directions to “ TEARA FOWLER ” Practice Location

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