Healthcare Provider Details

I. General information

NPI: 1346703139
Provider Name (Legal Business Name): KRISTINA MOUKSIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONCOURSE AVE STE 142
MEMPHIS TN
38104-4570
US

IV. Provider business mailing address

1350 CONCOURSE AVE STE 142
MEMPHIS TN
38104-4570
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-0003
  • Fax:
Mailing address:
  • Phone: 901-272-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70801
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: