Individual provider · Type 1 NPI

Kenneth Dorsey Tisdale, L.C.I.C.I., LMT #548

Contractor · Albuquerque, NM

NPI number 1962709956 Active

Practice location

201 Eubank Blvd NE, B1
Albuquerque, NM 87123

Call (505) 712-7585 Map

Mailing address

8400 Menaul Blvd, 8400 Menaul Blvd. NE. #217
Albuquerque, NM 87112

Specialties and licenses

TaxonomyCodeLicense
Contractor Primary 171W00000XLMT # 5488 (NM)

Contractor: For the purposes of the Health Care Provider Taxonomy, a contractor is limited to individuals who do construction or mechanical work to modify a patient's environment to accommodate a health condition. Contractors perform projects including, but not limited to, building wheelchair ramps, widening doorways, modifying personal vehicles, and making other improvements for patient access and movement. This code has no re…

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About NPI 1962709956

Kenneth Dorsey Tisdale, L.C.I.C.I., LMT #548's National Provider Identifier is 1962709956, issued on Feb 28, 2011. The primary taxonomy on file is Contractor (171W00000X), and the practice location is in Albuquerque, NM. The record was last updated on Feb 28, 2011.