Healthcare Provider Details

I. General information

NPI: 1164848289
Provider Name (Legal Business Name): KRISTINA RYNES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87112-2884
US

IV. Provider business mailing address

8810 VIDAL RD SW
ALBUQUERQUE NM
87105-7826
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-6383
  • Fax: 505-636-6338
Mailing address:
  • Phone: 505-307-5968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1252
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY-2022-0131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: