Provider Demographics
NPI:1073611372
Name:HESTER, REID KEVIN (PHD)
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:KEVIN
Last Name:HESTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9426 INDIAN SCHOOL RD NE
Mailing Address - Street 2:STE 1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112
Mailing Address - Country:US
Mailing Address - Phone:505-345-6100
Mailing Address - Fax:505-345-6100
Practice Address - Street 1:9426 INDIAN SCHOOL RD NE
Practice Address - Street 2:STE 1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-345-6100
Practice Address - Fax:505-345-6100
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN6598Medicaid
NM2507734Medicare ID - Type Unspecified
NMN6598Medicaid