Provider Demographics
NPI:1558566414
Name:KISE, KRISTINA LYN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYN
Last Name:KISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 N HYER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4629
Mailing Address - Country:US
Mailing Address - Phone:407-449-8937
Mailing Address - Fax:430-206-1780
Practice Address - Street 1:631 N HYER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4629
Practice Address - Country:US
Practice Address - Phone:407-449-8937
Practice Address - Fax:430-206-1780
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1081872084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry