Provider Demographics
NPI:1346703139
Name:MOUKSIAN, KRISTINA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:MOUKSIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONCOURSE AVE STE 142
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4570
Mailing Address - Country:US
Mailing Address - Phone:901-272-0003
Mailing Address - Fax:
Practice Address - Street 1:1350 CONCOURSE AVE STE 142
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4570
Practice Address - Country:US
Practice Address - Phone:901-272-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN70801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program