Provider Demographics
NPI:1093175424
Name:MOEN, KRISTIN ELIZABETH (RN, DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:MOEN
Suffix:
Gender:F
Credentials:RN, DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:CENTER FOR DEVELOPING HOPE
Mailing Address - Street 2:2075 NW GRANT AVE.
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-368-3152
Mailing Address - Fax:855-279-0612
Practice Address - Street 1:CENTER FOR DEVELOPING HOPE
Practice Address - Street 2:2075 NW GRANT AVE.
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-368-3152
Practice Address - Fax:855-279-0612
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR10000600363LP0808X
OR15-09-17101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)