MEDICARE: MRS. KRISTAL LYNNE JASTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	6430	NC
2	363A00000X	Physician Assistant	0010-04041	NC
3	363A00000X	Physician Assistant	007452	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	007452	OTHER	GA	PHYSICIAN ASSISTANT LICENSE

General Provider Information

NPI Number	:	1689768673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTAL LYNNE JASTER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 818
Second Line	:
City	:	SPRINGFIELD
State	:	GA
Zip	:	31329-0818
Country	:	US
Telephone Number	:
Fax Number	:	912-754-2570

Provider Business Practice Location Address
First Line	:	7306 GA HIGHWAY 21 STE 105
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9275
Country	:	US
Telephone Number	:	912-966-2575
Fax Number	:	912-966-0906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/17/2018

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Directions to “ MRS. KRISTAL LYNNE JASTER PA-C” Practice Location

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