Kimberly Detherow, APRN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AP141095 Issued in TX

Practice address

126 Main PLZ
San Antonio, TX 78205-2745

Phone

(888) 365-6271

NPI assigned

Mar 28, 2019

Sex

Female

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553731200000",
    "number": "1811458094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24015 AUGUSTA FALLS LN",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773894276",
            "telephone_number": "832-221-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 MAIN PLZ",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052745",
            "telephone_number": "888-365-6271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETHEROW",
        "first_name": "KIMBERLY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-28",
        "last_updated": "2019-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP141095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth F Desrosier, M.D.
• Ashton Dessert
• Desta Therapy, LLC
• Destination Independence LLC
• Detailed Dental, PLLC
• Brian P Deuell, MD
• Melissa S Deuter, MD
• Danielle Julia Deutschendorf, NP
• Madhavi Devagiri, M.D.
• Developmental Interventions, LLC

• Adult Health Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Adult Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.