Provider Demographics
NPI:1386026573
Name:CASSEL, KRISTA M (CPNP-PC, IBCLC)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:CASSEL
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Gender:
Credentials:CPNP-PC, IBCLC
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Other - First Name:
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Mailing Address - Street 1:500 BROOKSTONE CENTRE PARKWAY
Mailing Address - Street 2:#100
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-221-4602
Mailing Address - Fax:706-221-4620
Practice Address - Street 1:500 BROOKSTONE CENTRE PARKWAY
Practice Address - Street 2:#100
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-221-4602
Practice Address - Fax:706-221-4620
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN247812163WL0100X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162152HMedicaid