Healthcare Provider Details

I. General information

NPI: 1982438529
Provider Name (Legal Business Name): KRISTIN BARBARA LONSBERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 RIO RANCHO BLVD SE
ALBUQUERQUE NM
87124-1570
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-8610
  • Fax: 505-896-8618
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2024-0148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: