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Individual
KRISTA MOE
Active
Individual
KRISTA MOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1750
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100315990
—
KY
01
—
P01458492
RR MEDICARE
KY
Enumeration date
10/11/2011
Last updated
12/04/2020
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