# KRISTA MOE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1891079794
- **Gender:** F
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 1750 | KY | Yes |

## Other

- **Enumeration date:** 10/11/2011
- **Last updated:** 12/04/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100315990 | — | KY |
| 01 | — | P01458492 | RR MEDICARE | KY |