Healthcare Provider Details

I. General information

NPI: 1679077655
Provider Name (Legal Business Name): KRESTIN MASTERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 N EXPRESSWAY STE 121-123
GRIFFIN GA
30223-1753
US

IV. Provider business mailing address

1424 N EXPRESSWAY STE 121-123
GRIFFIN GA
30223-1753
US

V. Phone/Fax

Practice location:
  • Phone: 678-688-2820
  • Fax: 770-467-9868
Mailing address:
  • Phone: 678-688-2820
  • Fax: 770-467-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP336611
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: