Provider Demographics
NPI:1639960321
Name:DOMINGO, KRIS MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRIS MARIE
Middle Name:
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1157 AWAIKI PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3273
Mailing Address - Country:US
Mailing Address - Phone:808-725-8918
Mailing Address - Fax:
Practice Address - Street 1:94-1157 AWAIKI PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3273
Practice Address - Country:US
Practice Address - Phone:808-725-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-5179363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health