Provider Demographics
NPI:1053850040
Name:MOORE, CHRISTINA ADELE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ADELE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ADELE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:7360 W DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7774
Practice Address - Country:US
Practice Address - Phone:509-783-0144
Practice Address - Fax:509-783-8244
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN261111233363LA2200X
WAAP61104074363LA2200X, 363LF0000X
KS77577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health