| NPI | 1730583220 |
|---|---|
| Former Name | KRISTEN ANNE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09015) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 1989) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2022-12-30 |