Kenneth Dorsey Tisdale, L.C.I.C.I., LMT #548
NPI 1962709956ActiveIndividual· Contractor· Albuquerque, NM
Contractor (L.C.I.C.I., LMT #548) in Albuquerque, New Mexico, licensed in NM, with an NPI issued in February 2011.
Overview
| NPI | 1962709956 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | L.C.I.C.I., LMT #548 |
| Sole proprietor | Yes |
| NPI issued | Feb 28, 2011 |
| Last updated in NPPES | Feb 28, 2011 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Contractor Primary | 171W00000X | LMT # 5488 | NM |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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