Provider Demographics
NPI:1689768673
Name:JASTER, KRISTAL LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:LYNNE
Last Name:JASTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KRISTAL
Other - Middle Name:
Other - Last Name:JASTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:912-754-2570
Practice Address - Street 1:7306 GA HIGHWAY 21 STE 105
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-9275
Practice Address - Country:US
Practice Address - Phone:912-966-2575
Practice Address - Fax:912-966-0906
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6430124Q00000X
NC0010-04041363A00000X
GA007452363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA007452OtherPHYSICIAN ASSISTANT LICENSE