Bristow Run Family Medicine

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

0024173774 Issued in VA

Legal business name

BRISTOW RUN FAMILY MEDICINE

Practice address

14540 John Marshall Hwy
#104
Gainesville, VA 20155-1691

Phone

(703) 753-9799

NPI assigned

Jul 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer M Staley, FNP

Title

Family Nurse Practitioner

Phone

(919) 538-1712

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1801349915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 S THOMAS ST APT 1",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222043621",
            "telephone_number": "919-538-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 JOHN MARSHALL HWY",
            "address_2": "#104",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201551691",
            "telephone_number": "703-753-9799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOW RUN FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "STALEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "919-538-1712",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": "0024173774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverley E. Boothe-Mooring, LCSW
• Jennifer Bouchard, LPTA
• Leslie Karina Bourgeois, PT, DPT
• Kathryn Marie Bowler, LCSW
• Gurvir Brar
• Bristow Run Family Practice, PC
• Rebecca Brosch, PSY.D.
• Julia A Bruce, M.D.
• Sonya Lynn Bryce, NCC, LSATP, LPC
• Thu Anh Bui, PHARMD

• Clinic/Center in Gainesville, VA
• Providers in Gainesville, VA by specialty
• Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.