Provider Demographics
NPI:1760275002
Name:MOORE, KRISTEN VON
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:VON
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 SHAWS RUN RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26591-9154
Mailing Address - Country:US
Mailing Address - Phone:681-332-7741
Mailing Address - Fax:
Practice Address - Street 1:223 SHAWS RUN RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:WV
Practice Address - Zip Code:26591-9154
Practice Address - Country:US
Practice Address - Phone:681-332-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant