Provider Demographics
NPI:1568019750
Name:MAST, KRISTA (NP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1193 NORTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9526
Mailing Address - Country:US
Mailing Address - Phone:330-825-1152
Mailing Address - Fax:330-854-0829
Practice Address - Street 1:6724 WALES AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9006
Practice Address - Country:US
Practice Address - Phone:330-837-4264
Practice Address - Fax:330-837-9195
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025506363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health