Kenneth Brown

Individual provider Active NPI Peer Specialist · Albuquerque, NM

NPI 1679407597 · NPPES record last updated Jun 9, 2026

Key facts

NPI
1679407597
Entity type
Individual (NPI type 1)
Primary specialty
Peer Specialist 175T00000X
License
2010 (NM)
Practice address
13139 Central Ave NE
Albuquerque, NM 87123-3031
Phone
(505) 595-1607
NPI assigned
Jun 9, 2026
Sex
Unspecified or another gender identity
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Summit LLC Past
since Dec 1, 2024
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X 2010 NM Yes

Addresses

Primary practice location

13139 Central Ave NE
Albuquerque, NM 87123-3031

Mailing address

13139 Central Ave NE
Albuquerque, NM 87123-3031
Phone (505) 595-1607

Other providers in Albuquerque, NM

All providers in Albuquerque, NM · Peer Specialist in New Mexico

Sources for this page

Verify at the official NPI Registry.