Provider Demographics
NPI:1447642202
Name:MORIARITY, KRISTI
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MORIARITY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KRISTI
Other - Middle Name:MARIE
Other - Last Name:MORIARITY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-BC, APNP
Mailing Address - Street 1:1717 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-2405
Mailing Address - Country:US
Mailing Address - Phone:262-638-6744
Mailing Address - Fax:262-638-1529
Practice Address - Street 1:1717 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2405
Practice Address - Country:US
Practice Address - Phone:262-638-6744
Practice Address - Fax:262-633-1529
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129796163W00000X
WI6156363LP0808X
WI6156-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health