Provider Demographics
NPI:1043304439
Name:WILLS, KRISTA M (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:WILLS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:201 CEDAR ST SE STE 507
Practice Address - Street 2:PMG OB HOSPITALIST
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4925
Practice Address - Country:US
Practice Address - Phone:505-563-6381
Practice Address - Fax:505-563-6380
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-07-16
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM86147207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37440Medicaid
349606504Medicare PIN