Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Kenneth Dorsey Tisdale, LCICI, LMT548

Individual provider Contractor · NPI 1962709956

Kenneth Dorsey Tisdale, LCICI, LMT548 is a Contractor in Albuquerque, New Mexico. Practices as a sole proprietor. Licensed in New Mexico.

Licensed in
NM
In the registry since
2011
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Practice location Address checks out

201 Eubank Blvd NE B1
Albuquerque, NM 87123 Not confirmed with CMS for 15 years — call before visiting
Phone: (505) 712-7585
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Contractor (primary) Taxonomy 171W00000X · Licence LMT # 5488 (NM)

Record details

NPI number1962709956
Entity typeIndividual (Type 1)
GenderMale
Credentials LCICI , LMT548
Sole proprietorYes
NPI enumeratedFebruary 28, 2011
Last updated in NPPESFebruary 28, 2011

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