Healthcare Provider Details

I. General information

NPI: 1215645817
Provider Name (Legal Business Name): BRIANNA GASTON MSN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD STE 400
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

190 CAMPUS BLVD STE 400
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-1727
  • Fax: 540-722-3373
Mailing address:
  • Phone: 540-667-1727
  • Fax: 540-722-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024185740
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: