Provider Demographics
NPI:1255759304
Name:MEREDICK, KRISTIN (MD/MBA)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:MEREDICK
Suffix:
Gender:F
Credentials:MD/MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 HOLLY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2472
Mailing Address - Country:US
Mailing Address - Phone:505-298-2505
Mailing Address - Fax:
Practice Address - Street 1:5904 HOLLY AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2472
Practice Address - Country:US
Practice Address - Phone:505-298-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA149955208000000X
NMMD2025-0373208000000X
PAMD460271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics