Provider Demographics
NPI:1548779408
Name:KLEMENC, CRYSTAL MANSFIELD (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MANSFIELD
Last Name:KLEMENC
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 COLTMAN DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-5606
Mailing Address - Country:US
Mailing Address - Phone:770-789-0168
Mailing Address - Fax:
Practice Address - Street 1:3300 OLD MILTON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2425
Practice Address - Country:US
Practice Address - Phone:770-664-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-23
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily