CRYSTALINE JOI PROTHRO NP-C
NPI 1568060846
Nurse Practitioner - Family in Kennesaw, GA

Q: What is Crystaline Prothro's NPI number?

The NPI number for Crystaline Prothro is 1568060846. It was assigned to this individual provider in the NPPES registry on October 9, 2020.

Q: What is Crystaline Prothro's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since October 09, 2020PECOS EnrolledAccepts Medicare Assignment

2782 N COBB PKWY, KENNESAW, GA 30152(866) 389-2727 Get Directions Write a Review

NPPES record last updated: February 28, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 28, 2025, Feb 13, 2025, Jan 15, 2022 and 1 more (4 updates tracked since 2020).

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About Crystaline Joi Prothro Np-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CRYSTALINE JOI PROTHRO NP-C (NPI 1568060846) is an individual family provider in Kennesaw, Georgia, licensed in Georgia (RN233492) and active in the NPI registry since October 2020. She is enrolled in Medicare PECOS, maintains a secondary practice location in Roswell, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1568060846

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameCRYSTALINE JOI PROTHROCredential: NP-C

Location Address2782 N COBB PKWYKennesaw, GA 30152-3472

Mailing Address4010 Bryce Manor LnDecatur, GA 30034-6256 · (770) 912-9830

Phone(866) 389-2727

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateOctober 9, 2020

Last NPPES UpdateFebruary 28, 20254 updates tracked since enumeration

NPPES CertifiedFebruary 28, 2025

✔ NPI 1568060846 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in GA · RN233492

2782 N COBB PKWY, Kennesaw, GA 30152

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Secondary Practice Location 1

Location 11305 Hembree RdRoswell, GA 30076-3810 · Phone (470) 485-6342

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, BlueCross BlueShield of Tennessee.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Crystaline Joi Prothro Np-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9032639851

PECOS Enrollment IDI20250225000147, I20250911005015, I20251114002421

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30152 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.06 typical visit price

range $56.84 – $172.43

Typical copayment $22.01 (range $14.21 – $43.10)

Most-billed visit code 99203

Established Patient

$100.20 typical visit price

range $18.22 – $140.40

Typical copayment $25.05 (range $4.55 – $35.10)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHAD RICHARD

Pharmacist