Provider Demographics
NPI:1265320709
Name:KASTNER, KATIE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:KASTNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1779
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-1779
Mailing Address - Country:US
Mailing Address - Phone:706-892-8030
Mailing Address - Fax:706-754-5577
Practice Address - Street 1:590 441 HISTORIC HWY N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4561
Practice Address - Country:US
Practice Address - Phone:706-754-5511
Practice Address - Fax:706-754-5577
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA294671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty