Individual provider Active NPI

Crystal Mansfield Klemenc, FNP-BC

  • Family Nurse Practitioner
  • Cumming, GA
National Provider Identifier
1548779408
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN202822 Issued in GA
Practice address
5310 Matt Hwy Ste 103
Cumming, GA 30028-8611
Phone
(470) 239-4928
NPI assigned
Sep 23, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN202822 GA Primary

Addresses

Primary practice location

5310 Matt Hwy Ste 103
Cumming, GA 30028-8611

Mailing address

5315 Coltman Dr
Cumming, GA 30028-5606
Phone (770) 789-0168

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180717004215 GA Practitioner - Nurse Practitioner 4082961362 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maxfield Medical LLCGroup PAC ID 7618333121, 5 clinicians

Practice addresses (Care Compare)

5310 Matt Hwy
Suite 103
Cumming, GA 30028-8611
Phone (470) 789-2455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic LLC Family CurrentSince Mar 24, 2021 Accepting new patients
Maxfield Medical LLC CurrentSince Nov 6, 2023 Accepting new patients
Dunwoody Pediatrics PastSince Sep 4, 2022 Accepting new patients

Locations

3785 Sixes Rd
Canton, GA 30114
Phone (770) 720-3466

5310 Matt Hwy
Ste 103
Cumming, GA 30028
Phone (470) 239-4928

11710 Alpharetta Hwy
Roswell, GA 30076
Phone (770) 754-0141

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1548779408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5315 COLTMAN DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300285606",
            "telephone_number": "770-789-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 MATT HWY STE 103",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300288611",
            "telephone_number": "470-239-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEMENC",
        "first_name": "CRYSTAL",
        "middle_name": "MANSFIELD",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-23",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN202822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.