Provider Demographics
NPI:1922593326
Name:MORENO, KRISTEN J (PA)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:J
Last Name:MORENO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:600 GRESHAM DR STE 8610
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-252-9015
Mailing Address - Fax:757-510-9041
Practice Address - Street 1:600 GRESHAM DR STE 8610
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-252-9015
Practice Address - Fax:757-510-9041
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA363A00000X
VA0110006261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant