Individual
MRS. KRISTAL LYNNE JASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7306 GA HIGHWAY 21 STE 105, PORT WENTWORTH, GA 31407-9275
(912) 966-2575
(912) 966-0906
Mailing address
PO BOX 818, SPRINGFIELD, GA 31329-0818
(912) 754-2570
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
6430
NC
363A00000X
Physician Assistant
0010-04041
NC
363A00000X
Physician Assistant
Primary
007452
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007452
PHYSICIAN ASSISTANT LICENSE
GA
Enumeration date
10/03/2006
Last updated
03/17/2018
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