Provider Demographics
NPI:1437692035
Name:MONZA, KRISTIN HAYES (NP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:HAYES
Last Name:MONZA
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 1:1237 HARDING PLACE
Mailing Address - Street 2:4100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10660 PARK RD
Practice Address - Street 2:STE 3400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8413
Practice Address - Country:US
Practice Address - Phone:704-667-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009129363LG0600X, 363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437692035Medicaid
SCNP4259Medicaid
NCNCV767DMedicare PIN
NCNCV767C904Medicare PIN
NCNCV767CMedicare PIN
NC1437692035Medicaid
NCNCV767BMedicare PIN