Individual
KEVIN BETTENCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5901 HARPER DR NE, ALBUQUERQUE, NM 87109-3589
(505) 823-8233
(505) 823-8059
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00611
RI
363A00000X
Physician Assistant
Primary
PA2011-0012
NM
363A00000X
Physician Assistant
PAT9105615
FL
Other
Enumeration date
09/09/2010
Last updated
08/15/2016
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