Healthcare Provider Details

I. General information

NPI: 1306779152
Provider Name (Legal Business Name): TIRA GASTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2558 NE LINDSEY DR
HILLSBORO OR
97124-4125
US

IV. Provider business mailing address

2558 NE LINDSEY DR
HILLSBORO OR
97124-4125
US

V. Phone/Fax

Practice location:
  • Phone: 971-500-2946
  • Fax:
Mailing address:
  • Phone: 971-500-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10016991
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: