1790719763 NPI number — DR. KRISTIN MICHELLE KEAST PH.D.

Table of content: CHRISTINE M GRAY LCSW (NPI 1811369440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790719763 NPI number — DR. KRISTIN MICHELLE KEAST PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEAST
Provider First Name:
KRISTIN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIXON
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790719763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 WAIALAE AVE APT A905
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96816-5740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-561-2305
Provider Business Mailing Address Fax Number:
808-737-1010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46-001 KAMEHAMEHA HWY STE 409
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANEOHE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96744-3749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-561-2305
Provider Business Practice Location Address Fax Number:
808-737-1010
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 778 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY 16522 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 244392 . This is a "TRICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 244392 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 554792-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".