KEVIN BETTENCOURT

ALBUQUERQUE, NM
NPI1730496977
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: NM  PA2011-0012)
Additional Taxonomies363A00000X Physician Assistant
(Licence: RI  PA00611)
363A00000X Physician Assistant
(Licence: FL  PAT9105615)
Enumeration Date2010-09-09
Last Update Date2016-08-15
Business Address
-- KEVIN BETTENCOURT PA-C
5901 HARPER DR NE
ALBUQUERQUE, NM 87109-3589
Phone number: 505-823-8233
Mailing Address
-- KEVIN BETTENCOURT PA-C
PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE, NM 87125-6666
Phone number: 505-923-6770