Provider Demographics
NPI:1851520068
Name:WILD, KRISTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:WILD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:L
Other - Last Name:WILD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:CENTER FOR NEUROPSYCHOLOGICAL SVCS, DEPT OF PSYCHIATRY
Mailing Address - Street 2:MSC 09 5030, 1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-925-6061
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO, MSC 09 5030
Practice Address - Street 2:CENTER FOR NEUROPSYCHOLOGICAL SVCS, DEPT OF PSYCHIATRY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-925-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist