Provider Demographics
NPI:1891097283
Name:BEGAY, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BEGAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W NIZHONI BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5766
Mailing Address - Country:US
Mailing Address - Phone:505-722-9470
Mailing Address - Fax:505-722-9570
Practice Address - Street 1:300 W NIZHONI BLVD STE A
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5766
Practice Address - Country:US
Practice Address - Phone:505-722-9470
Practice Address - Fax:505-722-9570
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator