Individual
KENNETH ROGER SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCSS
Contact information
Practice address
2004 VALENCIA DR NE, ALBUQUERQUE, NM 87110-5210
(505) 398-7843
Mailing address
2004 VALENCIA DR NE, ALBUQUERQUE, NM 87110-5210
(505) 398-7843
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
NM
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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