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Active NPI 1962709956 Individual Practitioner Male Practitioner

Kenneth Dorsey Tisdale , LCICI, LMT #548

Contractor • Albuquerque, NM

Professional Overview & Biography Verified Profile Summary

Kenneth Tisdale, LCICI, LMT #548 is a registered healthcare professional specializing in Contractor in Albuquerque, NM. Practice services are available at 201 EUBANK BLVD NE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

201 Eubank Blvd Ne
B1

Albuquerque, NM 87123

Telephone 5057127585
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Contractor in Albuquerque, NM

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
31 Specialists

Practicing in Albuquerque, NM (65 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Contractor Primary Specialty

NUCC Taxonomy Code: 171W00000X

State License NM LMT # 5488

A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering).

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1255342218

Licensed Massage Therapist

Ross Davidson , MA, LMFT

Marriage & Family Therapist

NPI 1912064908

Master of Arts, Licensed Marriage and Family Therapist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active February 28, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location February 28, 2011

Registered at 201 EUBANK BLVD NE, B1, ALBUQUERQUE, NM 87123 (Tel: 5057127585)

📍
Updated Business Mailing Address February 28, 2011

Registered at 8400 MENAUL BLVD, 8400 MENAUL BLVD. NE. #217, ALBUQUERQUE, NM 87112 (Tel: 5057127585)

👤
Provider Name / Credentials Updated February 28, 2011

Recorded as KENNETH TISDALE, L.C.I.C.I., LMT #548

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 28, 2011

Contractor (License #LMT # 5488 in NM)

🟢
Initial NPI Registration & Enumeration February 28, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1962709956
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 28, 2011
Last Update: February 28, 2011
Sole Proprietor: Yes

Mailing Address

8400 Menaul Blvd, 8400 Menaul Blvd. Ne. #217

Albuquerque, NM 87112

Phone: 5057127585

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.