Healthcare Provider Details

I. General information

NPI: 1891620076
Provider Name (Legal Business Name): KRISTEN MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25439 SCHAFF DRIVE
CHUGIAK AK
99567
US

IV. Provider business mailing address

PO BOX 672629
CHUGIAK AK
99567-2629
US

V. Phone/Fax

Practice location:
  • Phone: 907-854-7033
  • Fax:
Mailing address:
  • Phone: 907-854-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number2225024
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: