IndividualActive
Kenneth Wetherholt, CSFA
NPI 1073283693 · Independent Duty Corpsman · San Antonio, TX
Provider details
- NPI number
- 1073283693
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- CSFA
- Sex
- Male
- Sole proprietor
- Yes
- License
- 194476
Specialties & taxonomies
Other Service Providers
Technologists, Technicians & Other Technical Service Providers
Practice location
8626 Tesoro Dr Ste 502
San Antonio, TX 78217-6217
Phone: (210) 496-2222
Approximate (ZIP-level) locationGet directions
Mailing address
102 Deerwood Dr
Groton, CT 06340-2516
Registry dates
- Enumerated
- 2021-09-15
- Last updated
- 2025-07-31
- Certified
- 2025-07-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.