MEDICARE: KRISTINA LYN KISE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME108187	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME108187	FL

General Provider Information

NPI Number	:	1558566414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA LYN KISE M.D.

Provider Business Mailing Address
First Line	:	545 DELANEY AVE STE 5
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3866
Country	:	US
Telephone Number	:	407-449-8937
Fax Number	:	430-206-1780

Provider Business Practice Location Address
First Line	:	545 DELANEY AVE STE 5
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3866
Country	:	US
Telephone Number	:	407-449-8937
Fax Number	:	430-206-1780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	02/27/2026

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