Provider Demographics
NPI:1164848289
Name:RYNES, KRISTINA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:RYNES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 VIDAL RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7826
Mailing Address - Country:US
Mailing Address - Phone:505-307-5968
Mailing Address - Fax:
Practice Address - Street 1:9301 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2884
Practice Address - Country:US
Practice Address - Phone:505-218-6383
Practice Address - Fax:505-636-6338
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1252103TC0700X
NMPSY-2022-0131103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM25531026Medicaid