Provider Demographics
NPI:1790719763
Name:KEAST, KRISTIN MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:KEAST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:MICHELLE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4300 WAIALAE AVE APT A905
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5740
Mailing Address - Country:US
Mailing Address - Phone:808-561-2305
Mailing Address - Fax:808-737-1010
Practice Address - Street 1:46-001 KAMEHAMEHA HWY STE 409
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3749
Practice Address - Country:US
Practice Address - Phone:808-561-2305
Practice Address - Fax:808-737-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 778103TC0700X
CAPSY 16522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI244392OtherTRICARE
HI244392OtherHMSA
HI554792-01Medicaid
HI554792-01Medicaid