Healthcare Provider Details

I. General information

NPI: 1114940111
Provider Name (Legal Business Name): KRISTEN DANIELLE THOMAS-MOOREHEAD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CITRUS GROVE LN #150
OXNARD CA
93036-9030
US

IV. Provider business mailing address

2705 LOMA VISTA RD SUITE 205
VENTURA CA
93003-1581
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-3770
  • Fax: 805-981-3767
Mailing address:
  • Phone: 805-667-2801
  • Fax: 805-667-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number388958
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: