Individual
MR. KENNETH DANIEL COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW, CSHPS
Contact information
Practice address
2915 W HISTORIC HIGHWAY 66 RM 1203, GALLUP, NM 87301-6812
(505) 870-1483
Mailing address
PO BOX 3809, GALLUP, NM 87305-3809
(505) 330-1884
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1336
NM
Other
Enumeration date
02/21/2024
Last updated
03/08/2024
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