Kenneth Sean Willeford, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT3465 Issued in TX

Practice address

3005 Stadium Drive
Fort Worth, TX 76109

Phone

(817) 257-6737

Fax

(817) 257-7702

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376637223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "TCU BOX 297730",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76129",
            "telephone_number": "817-257-6737",
            "fax_number": "817-257-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 STADIUM DRIVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76109",
            "telephone_number": "817-257-6737",
            "fax_number": "817-257-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEFORD",
        "first_name": "KENNETH",
        "middle_name": "SEAN",
        "name_prefix": "Mr.",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT3465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fawn Marie Willard, FNP
• John Edward Willard, MD
• Erin Colleen Willbanks, PMHNP
• Braden Chase Willburn, RN
• Michael D Willcutts, MD
• Christina Willens, PTA
• Leah Willett, DC
• William C Bridges MD & Associates
• William Drost Altig, O.D., P.C.
• William F Cothern, D.O., P.a.

• Athletic Trainer in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.