Provider Demographics
NPI:1326255803
Name:GASTON, RICHARD BARRY (CRNP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BARRY
Last Name:GASTON
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SAVANNAH ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604
Mailing Address - Country:US
Mailing Address - Phone:251-436-2253
Mailing Address - Fax:251-436-5003
Practice Address - Street 1:1379 CIBA RD
Practice Address - Street 2:
Practice Address - City:MCINTOSH
Practice Address - State:AL
Practice Address - Zip Code:36553
Practice Address - Country:US
Practice Address - Phone:251-436-2253
Practice Address - Fax:251-436-5003
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-072663363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health