Provider Demographics
NPI:1538726203
Name:BRIGHTSTONE, LLC
Entity type:Organization
Organization Name:BRIGHTSTONE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, AGNP-C
Authorized Official - Phone:202-888-4959
Mailing Address - Street 1:10040 PENTLAND HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2665
Mailing Address - Country:US
Mailing Address - Phone:202-497-8348
Mailing Address - Fax:
Practice Address - Street 1:10040 PENTLAND HILLS WAY
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136
Practice Address - Country:US
Practice Address - Phone:202-888-4959
Practice Address - Fax:703-995-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10145009Medicaid