Kirstin Shaffer, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12010 Issued in GA

Practice address

1002 Williamsburg Way
Evans, GA 30809-7615

Phone

(706) 922-3376

Fax

(706) 922-5643

NPI assigned

Sep 13, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evans Dermatology, LLCGroup PAC ID 0446310023, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Evans Dermatology, LLC

  • Specialist
  • Evans, GA
  • NPI 1083862577
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1619754512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 FOTHERGILL DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308097242",
            "telephone_number": "706-691-9252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 WILLIAMSBURG WAY",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308097615",
            "telephone_number": "706-922-3376",
            "fax_number": "706-922-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "KIRSTIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-13",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keziah Shantia Scott
• Laura Drake Scott, DMD
• Sonja Scott
• Joshua Screws
• Macy Salter Sepulveda
• Purvi K Shah, PA
• Bethany Shaw, RBT
• Kenneth Steven Shaw, O.D.
• Lisa Marie Sheehan, M.D.
• Bozeman K Sherwood, MD

• Physician Assistant in Evans, GA
• Providers in Evans, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.