Individual
JEFFERSON JACKSON WETHERINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
600 N ROBBINS RD STE 200, BOISE, ID 83702-4565
(616) 447-9996
Mailing address
600 N ROBBINS RD STE 401, BOISE, ID 83702-4566
(208) 706-9439
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
10160747
OR
2255A2300X
Athletic Trainer
2601001331
MI
2255A2300X
Athletic Trainer
AL 2738
FL
2255A2300X
Athletic Trainer
Primary
AT468
ID
246Z00000X
Other Specialist/Technologist
#13-0839
ID
Other
Enumeration date
10/09/2009
Last updated
03/19/2020
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