Healthcare Provider Details

I. General information

NPI: 1770492605
Provider Name (Legal Business Name): KRYSTENA JOANNE PRIDDY PSR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY STE D
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

1001 W BROADWAY STE D
FARMINGTON NM
87401-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax: 505-443-8335
Mailing address:
  • Phone: 505-327-4796
  • Fax: 505-443-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: