Kenneth Kelly
Individual provider Active NPI School Psychologist · Aztec, NM
NPI 1336364660 · NPPES record last updated Aug 18, 2010
Key facts
- NPI
- 1336364660
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- Practice address
- 1118 W Aztec Blvd
Aztec, NM 87410-1818 - Phone
- (505) 334-3695
- NPI assigned
- Apr 13, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aztec Municipal Schools | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | AZ | Yes |
Addresses
Primary practice location
1118 W Aztec Blvd
Aztec, NM 87410-1818
Mailing address
212 N Valley Blvd
Bloomfield, NM 87413-5749
Phone (602) 999-3618
Other providers in Aztec, NM
- Christen Marie Janney
- Kendill May Jones
- Kare Inc
- Kare Inc
- Heidi Lisa Karst
- Ian Thorsten Kirste
- Shyla Kowach
- Diane Kresl
- Annikah Mae Lamery
- Rebecca Grace Larivee
All providers in Aztec, NM · School Psychologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.