Healthcare Provider Details

I. General information

NPI: 1386026573
Provider Name (Legal Business Name): KRISTA M CASSEL CPNP-PC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BROOKSTONE CENTRE PARKWAY #100
COLUMBUS GA
31904
US

IV. Provider business mailing address

500 BROOKSTONE CENTRE PARKWAY #100
COLUMBUS GA
31904
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-4602
  • Fax: 706-221-4620
Mailing address:
  • Phone: 706-221-4602
  • Fax: 706-221-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN247812
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN247812
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: