Healthcare Provider Details

I. General information

NPI: 1730981580
Provider Name (Legal Business Name): PEYTON MAST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 NEIL AVE
COLUMBUS OH
43201-2320
US

IV. Provider business mailing address

1577 NEIL AVE
COLUMBUS OH
43210-1216
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-1495
  • Fax:
Mailing address:
  • Phone: 614-873-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.004057
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.490487
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: