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NPI Code Detail

MEDICARE: JAMES WOODY WETHINGTON I

MEDICARE: JAMES WOODY WETHINGTON I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistCAPRC2-5137IN

General Provider Information

NPI Number : 1043166838
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WOODY WETHINGTON I
Provider Business Mailing Address
First Line : 7801 S FRANKLIN RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46259-9630
Country : US
Telephone Number : 317-363-3459
Fax Number :
Provider Business Practice Location Address
First Line : 1234 N COURTLAND AVE
Second Line :
City : KOKOMO
State : IN
Zip : 46901-2754
Country : US
Telephone Number : 317-363-3459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2026
Last Update Date : 03/05/2026

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