Provider Demographics
NPI:1619515764
Name:KENT, JOEL MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:MICHAEL
Last Name:KENT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:460 SAINT MICHAELS DR STE 1104
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7709
Mailing Address - Country:US
Mailing Address - Phone:505-820-2562
Mailing Address - Fax:505-795-7123
Practice Address - Street 1:460 SAINT MICHAELS DR STE 1104
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7709
Practice Address - Country:US
Practice Address - Phone:505-820-2562
Practice Address - Fax:505-795-7123
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2020-0023207Q00000X, 363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine