Healthcare Provider Details

I. General information

NPI: 1972693471
Provider Name (Legal Business Name): JACQUELINE F FOURNIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27760 RANCH ROAD 12 BLDG 1
DRIPPING SPRINGS TX
78620
US

IV. Provider business mailing address

6210 E US HWY 290 STE 420 - CREDENTIALING
AUSTIN TX
78723-1098
US

V. Phone/Fax

Practice location:
  • Phone: 512-829-9118
  • Fax: 512-406-7301
Mailing address:
  • Phone: 512-338-3826
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK2903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: