Healthcare Provider Details

I. General information

NPI: 1699579177
Provider Name (Legal Business Name): KENDALL LEEANN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E CHALLENGER ST
ROSWELL NM
88203-8452
US

IV. Provider business mailing address

PO BOX 3141
CARLSBAD NM
88221-3141
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5552
  • Fax: 575-725-5552
Mailing address:
  • Phone: 575-725-5552
  • Fax: 575-725-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0890
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: