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General NPI Number Information
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NPI Number | 1689768673
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Entity Type | Individual
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Provider Name | KRISTAL LYNNE JASTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 7306 GA HIGHWAY 21 STE 105
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-9275
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Country | US
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Telephone | 912-966-2575
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Fax | 912-966-0906
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Provider Business Mailing Address
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Address Line | PO BOX 818
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City | SPRINGFIELD
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State | GA
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Zip | 31329-0818
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Country | US
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Telephone |
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Fax | 912-754-2570
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 6430
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-04041
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 007452
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License Number State | GA
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