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General NPI Number Information
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NPI Number | 1538726203
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Entity Type | Organization
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Legal Business Name | BRIGHTSTONE, LLC
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 10040 PENTLAND HILLS WAY
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City | BRISTOW
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State | VA
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Zip | 20136
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Country | US
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Telephone | 202-888-4959
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Fax | 703-995-0930
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Provider Business Mailing Address
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Address Line | 10040 PENTLAND HILLS WAY
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City | BRISTOW
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State | VA
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Zip | 20136-2665
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Country | US
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Telephone | 202-497-8348
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHANNA LYNN GASKINS
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Credential | DNP, APRN, AGNP-C
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Telephone | 202-888-4959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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