MEDICARE: LAUREN HEALY CARPENTER MS, LAT, ATC

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	2255A2300X	Athletic Trainer	1647	SC

General Provider Information

NPI Number	:	1366248627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN HEALY CARPENTER MS, LAT, ATC

Provider Business Mailing Address
First Line	:	716 LANTERN WALK DR UNIT 2204
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8775
Country	:	US
Telephone Number	:	704-352-7624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 SEA MOUNTAIN HWY
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7860
Country	:	US
Telephone Number	:	843-399-6171
Fax Number	:

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

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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