Provider Demographics
NPI:1336771419
Name:GASTON, KATIE (APRN, WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:GASTON
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 CORDOVA CV STE 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2220
Mailing Address - Country:US
Mailing Address - Phone:901-509-2714
Mailing Address - Fax:901-509-2704
Practice Address - Street 1:1374 CORDOVA CV STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2220
Practice Address - Country:US
Practice Address - Phone:901-509-2714
Practice Address - Fax:901-509-2704
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX839396163WW0101X
TX1003514207VX0000X, 363LW0102X
TN36398363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics