Healthcare Provider Details

I. General information

NPI: 1407760002
Provider Name (Legal Business Name): CHRISTOPHER KILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 JEFFERSON LN NE STE A
ALBUQUERQUE NM
87109-2151
US

IV. Provider business mailing address

5204 STREAM STONE AVE NW
ALBUQUERQUE NM
87114-4253
US

V. Phone/Fax

Practice location:
  • Phone: 505-361-1931
  • Fax:
Mailing address:
  • Phone: 505-361-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA1085
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: