Individual
KIMBERLY DETHEROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
126 MAIN PLZ, SAN ANTONIO, TX 78205-2745
(888) 365-6271
Mailing address
24015 AUGUSTA FALLS LN, SPRING, TX 77389-4276
(832) 221-7098
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP141095
TX
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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