Provider Demographics
NPI:1790430403
Name:WEED, KRIS JOHN SR
Entity Type:Individual
Prefix:MR
First Name:KRIS
Middle Name:JOHN
Last Name:WEED
Suffix:SR
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 1:1501 INDIAN SCHOOL RD NE APT H210
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1696
Mailing Address - Country:US
Mailing Address - Phone:505-225-7661
Mailing Address - Fax:505-967-1969
Practice Address - Street 1:1501 INDIAN SCHOOL RD NE APT H210
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1696
Practice Address - Country:US
Practice Address - Phone:505-225-7661
Practice Address - Fax:505-967-1969
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician