Provider Demographics
NPI:1194405258
Name:MOODY, KRISTIN (CNM)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WHITEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:ME
Mailing Address - Zip Code:04345-5179
Mailing Address - Country:US
Mailing Address - Phone:120-732-2771
Mailing Address - Fax:
Practice Address - Street 1:12 HIGH ST STE 200
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7689
Practice Address - Country:US
Practice Address - Phone:207-795-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife