Provider Demographics
NPI:1376001933
Name:MOORE, KRISTINE LEIGH (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5691 MEAD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:OH
Mailing Address - Zip Code:44099-8700
Mailing Address - Country:US
Mailing Address - Phone:440-563-6830
Mailing Address - Fax:
Practice Address - Street 1:36100 EUCLID AVE STE 420
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4429
Practice Address - Country:US
Practice Address - Phone:440-946-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAG06180251363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology