Healthcare Provider Details

I. General information

NPI: 1679261911
Provider Name (Legal Business Name): KRISTIN LARSEN MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN LARSEN

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 RED RIVER ST
AUSTIN TX
78712-1845
US

IV. Provider business mailing address

1745 PEACHTREE ST NE STE U
ATLANTA GA
30309-2479
US

V. Phone/Fax

Practice location:
  • Phone: 512-495-5555
  • Fax:
Mailing address:
  • Phone: 404-365-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number764827
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number764827
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number764827
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number764827
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number764827
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number764827
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number764827
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number764827
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number764827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: