Healthcare Provider Details

I. General information

NPI: 1730820713
Provider Name (Legal Business Name): KRISTEN JOAN PERRI RICE MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN JOAN PERRI RICE MOORE MD

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-0100
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMMD.96836MD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: