KENNETH DORSEY TISDALE L.C.I.C.I., LMT #548
NPI 1962709956
Contractor in Albuquerque, NM

Active since February 28, 2011
201 EUBANK BLVD NE, B1, ALBUQUERQUE, NM 87123(505) 712-7585 Get Directions Write a Review

NPPES record last updated: February 28, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kenneth Dorsey Tisdale L.c.i.c.i., Lmt #548 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH DORSEY TISDALE L.C.I.C.I., LMT #548 (NPI 1962709956) is an individual contractor provider in Albuquerque, New Mexico, licensed in New Mexico (LMT # 5488) and active in the NPI registry since February 2011.

NPPES Registry Identity

NPI1962709956
Entity TypeIndividualMale
Primary Taxonomy171W00000X
Provider Legal NameKENNETH DORSEY TISDALECredential: L.C.I.C.I., LMT #548
Location Address201 EUBANK BLVD NE, B1Albuquerque, NM 87123
Mailing Address8400 Menaul Blvd, 8400 Menaul Blvd. Ne. #217Albuquerque, NM 87112 · (505) 712-7585
Sole ProprietorYes
Enumeration DateFebruary 28, 2011
NPI 1962709956 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyContractorOther Service Providers
Taxonomy Code171W00000X
License Licensed in NM · LMT # 5488
Definition
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 relation to a provider's employment status.
201 EUBANK BLVD NE, Albuquerque, NM 87123

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Massage Therapist
201 EUBANK BLVD NE, STE. A3
ALBUQUERQUE, NM 87123
Marriage & Family Therapist
201 EUBANK BLVD NE, SUITE D-2B
ALBUQUERQUE, NM 87123
Marriage & Family Therapist
201 EUBANK BLVD NE, SUITE D-2B
ALBUQUERQUE, NM 87123

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Tisdale's NPI number?

The NPI number for Kenneth Tisdale is 1962709956. It was assigned to this individual provider in the NPPES registry on February 28, 2011.

Where is Kenneth Tisdale located?

Kenneth Tisdale practices at 201 Eubank Blvd NE B1, Albuquerque, NM 87123. The listed phone number is (505) 712-7585.

What is Kenneth Tisdale's specialty?

The primary specialty registered for this NPI is Contractor with taxonomy code 171W00000X.

When was this NPI record last updated?

The NPPES record for Kenneth Tisdale was last updated on February 28, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.