Provider Demographics
NPI:1114940111
Name:THOMAS-MOOREHEAD, KRISTEN DANIELLE (NP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DANIELLE
Last Name:THOMAS-MOOREHEAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 LOMA VISTA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1581
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:250 CITRUS GROVE LN
Practice Address - Street 2:#150
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-9030
Practice Address - Country:US
Practice Address - Phone:805-981-3770
Practice Address - Fax:805-981-3767
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388958163W00000X
CA7452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08609FMedicaid
CARHM18553HMedicaid
CARHM08608FMedicaid
CA95-1683892OtherOTHER INSURANCE
CAZZT40394FMedicaid
CARHM08609FMedicaid
CARHM08608FMedicaid
CAWNP7452IMedicare ID - Type UnspecifiedPPIN
CAWNP7452DMedicare ID - Type UnspecifiedPPIN
CAWNP7452GMedicare ID - Type UnspecifiedPPIN
CAWNP7452JMedicare ID - Type UnspecifiedPPIN
CAS55118Medicare UPIN
CAWNP7452EMedicare ID - Type UnspecifiedPPIN