Provider Demographics
NPI:1851651749
Name:MOORE, KRISTYN LAUREN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTYN
Middle Name:LAUREN
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CIENAGA ST SPC 55
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-8975
Mailing Address - Country:US
Mailing Address - Phone:405-399-0005
Mailing Address - Fax:
Practice Address - Street 1:2700 CIENAGA ST SPC 55
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445-8975
Practice Address - Country:US
Practice Address - Phone:405-399-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818807163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse