Provider Demographics
NPI:1265422265
Name:REIDY, KRISTIN E (DO)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:REIDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:2947 RODEO PARK DR E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6303
Practice Address - Country:US
Practice Address - Phone:505-983-6613
Practice Address - Fax:505-986-9984
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMA-1152-01207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM180044928OtherRRB MEDICARE RAILROAD
AZ702234Medicaid
NM25856316Medicaid
NMNM004A00OtherBC BS OF NM
NMH64237Medicare UPIN
NM$$$$$$$$$Medicare PIN