Provider Demographics
NPI:1891194239
Name:MOYER, KRISTY (RN)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MOYER
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 1:224 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-1204
Mailing Address - Country:US
Mailing Address - Phone:610-698-3775
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY VIEW
Practice Address - State:PA
Practice Address - Zip Code:17983-9407
Practice Address - Country:US
Practice Address - Phone:570-682-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN548499163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse