Provider Demographics
NPI:1386026573
Name:CASSEL, KRISTA M (CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:CASSEL
Suffix:
Gender:F
Credentials:CPNP
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Other - First Name:
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Mailing Address - Street 1:500 BROOKSTONE CENTRE PARKWAY
Mailing Address - Street 2:#100
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-221-4602
Mailing Address - Fax:706-221-4620
Practice Address - Street 1:500 BROOKSTONE CENTRE PARKWAY
Practice Address - Street 2:#100
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-221-4602
Practice Address - Fax:706-221-4620
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2022-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN247812363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162152HMedicaid