Provider Demographics
NPI:1558497875
Name:MOORE, KRISTINA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-723 HOONANI PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2413
Mailing Address - Country:US
Mailing Address - Phone:808-258-1119
Mailing Address - Fax:808-236-0207
Practice Address - Street 1:44-723 HOONANI PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2413
Practice Address - Country:US
Practice Address - Phone:808-258-1119
Practice Address - Fax:808-236-0207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49449301Medicaid