Provider Demographics
NPI:1447706148
Name:MOFFETT, KRISTINA (RN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E WINROW AVE
Mailing Address - Street 2:RAYMOND W BLISS AHC
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7079
Mailing Address - Country:US
Mailing Address - Phone:520-678-8375
Mailing Address - Fax:
Practice Address - Street 1:2240 E WINROW AVE
Practice Address - Street 2:RAYMOND W BLISS AHC
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7079
Practice Address - Country:US
Practice Address - Phone:520-678-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse