Provider Demographics
NPI:1245959956
Name:WAKING SKY PSYCHIATRY LLC
Entity type:Organization
Organization Name:WAKING SKY PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,PMHNP-BC
Authorized Official - Phone:970-987-7621
Mailing Address - Street 1:1925 ASPEN DR STE 700B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5470
Mailing Address - Country:US
Mailing Address - Phone:505-376-2749
Mailing Address - Fax:505-424-3321
Practice Address - Street 1:1925 ASPEN DR STE 700B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5470
Practice Address - Country:US
Practice Address - Phone:505-376-2749
Practice Address - Fax:505-424-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty