Healthcare Provider Details

I. General information

NPI: 1245959956
Provider Name (Legal Business Name): WAKING SKY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 02/08/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

1448 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

V. Phone/Fax

Practice location:
  • Phone: 505-376-2749
  • Fax: 505-424-3321
Mailing address:
  • Phone: 505-376-2749
  • Fax: 505-424-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN E KENYON
Title or Position: NP
Credential: MSN/PMHNP-BC
Phone: 505-376-2749