Provider Demographics
NPI:1497481253
Name:TENORIO, KIERSTEN
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:TENORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6621
Mailing Address - Country:US
Mailing Address - Phone:505-999-0292
Mailing Address - Fax:
Practice Address - Street 1:689 CAROLINA DR
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6621
Practice Address - Country:US
Practice Address - Phone:505-999-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician