Individual
KEVIN RYAN PUCKETT I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAA
Contact information
Practice address
1528 FIVE POINTS RD SW, ALBUQUERQUE, NM 87105-3179
(505) 242-6919
Mailing address
1805 LLANO CT NW, ALBUQUERQUE, NM 87107-2631
(505) 506-7595
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
CSA0210841
NM
Other
Enumeration date
08/25/2020
Last updated
08/25/2020
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