Healthcare Provider Details

I. General information

NPI: 1568019750
Provider Name (Legal Business Name): KRISTA MAST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6724 WALES AVE NW
MASSILLON OH
44646-9006
US

IV. Provider business mailing address

1193 NORTON AVE STE A
NORTON OH
44203-9526
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-4264
  • Fax: 330-837-9195
Mailing address:
  • Phone: 330-825-1152
  • Fax: 330-854-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number025506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: