KELSEY GLEASON


Address: 1055 N 500 W Ste 121, Provo, UT 84604
Phone: 8013737350

KELSEY GLEASON (NPI# 1205217890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1205217890
Entity Type Individual
Full Name KELSEY GLEASON
Other Name KELSEY KOEPPEL
Credential PA-C
Practice Address 1055 N 500 W Ste 121
Provo
UT 84604
Mailing Address 1055 N 500 W
Att: Credentialing
Provo
UT 84604-3305
Practice Telephone 8013737350
Practice Fax Number 8018125401
Mailing Telephone 8013548225
Mailing Fax Number 8014180941
Enumeration Date 2015-06-09
Last Update Date 2020-03-31
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363A00000X Physician Assistant 11085884-1206 UT Physician Assistants & Advanced Practice Nursing Providers
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
11085884-1206 UT Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
700 W 800 N Ste 100, Orem, UT 840576301 8013737350 8012245337
1055 N 500 W Ste 121, Provo, UT 84604 8013737350 8018125401

Other Providers KELSEY GLEASON

NPI Name Taxonomy Address Enumeration
1740811165 Kelsey Gleason Counselor 125 Catherine Ave, Muskegon, MI 49442-3331 2020-02-04

Office Location

Street Address 1055 N 500 W STE 121
City PROVO
State UT
Zip Code 84604

Providers in the same location

NPI Name Taxonomy Address Enumeration
1255517488 William R. Mathie Physician Assistant 1055 N 500 W Ste 121, Provo, UT 84604-3305 2008-01-17
1477031870 Timothy Ross Carroll Physician Assistant 1055 N 500 W Ste 121, Provo, UT 84604-3305 2018-07-30
1053856542 Zachary David Golden Physician Assistant 1055 N 500 W Ste 121, Provo, UT 84604-3305 2016-12-20
1427463330 Todd Michael Gilbert Orthopaedic Surgery 1055 N 500 W Ste 121, Provo, UT 84604-3305 2014-06-30
1336302546 Benjamin Steven Crouch Physical Medicine & Rehabilitation 1055 N 500 W Ste 121, Provo, UT 84604-3305 2008-07-08

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1346882107 Abigail Belle Hardy Student in an Organized Health Care Education/Training Program 1190 900 E, Provo, UT 84604 2019-10-14
1386106698 Sarah Roseman Hunt Nurse Practitioner 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 2019-04-04
1255813325 Hwigeum Jeong Specialist/Technologist Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 2018-09-05
1093203044 Snowcap Smile Studio LLC Dentist 2230 N. University Pkwy Ste 8b, Provo, UT 84604 2018-04-25
1407359078 Ihc Health Services Inc Clinic/Center 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 2018-03-09
1902308455 Afton Leuga Nurse Practitioner 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 2018-03-01
1851807333 Ihc Health Services Inc Family Medicine 380 W 1230 N, Ste 602, Provo, UT 84604 2017-12-20
1689180218 Ihc Health Services Inc Pediatrics 395 W Bulldog Blvd Ste 703, Provo, UT 84604 2017-12-19
1396254165 Nicolas Sorensen Massage Therapist 247 West 2230 North #201, Provo, UT 84604 2017-09-25
1437692241 Cirque Lodge Inc Substance Abuse Rehabilitation Facility 3114 E Ida's Road, Sundance, UT 84604 2016-11-28
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1164666061 Stephen A Loper Physician Assistant 1055 N 500 W Ste 211, Provo, UT 84604-3305 2009-04-23
1255517488 William R. Mathie Physician Assistant 1055 N 500 W Ste 121, Provo, UT 84604-3305 2008-01-17
1023352952 Joan Margaret Butler Physician Assistant 750 N Freedom Blvd, Provo, UT 84601-1677 2012-11-15
1588928097 Brady Charles Norton Physician Assistant 1055 N 500 W, Provo, UT 84604-3305 2012-06-28
1184984320 Daniel Christensen Physician Assistant 1055 N 500 W Ste 207, Provo, UT 84604-3305 2012-05-22
1184930786 Drew Kenner Lambourne Physician Assistant 1055 N 500 W, Suite 121, Provo, UT 84604-3305 2010-08-20
1851625255 Jami Z Mckell Physician Assistant 1034 N 500 W, Provo, UT 84604-3380 2009-10-01
1730318445 Stephen Cruze Physician Assistant 1055 N 500 W, Suite 121, Provo, UT 84604-3305 2009-07-02
1205024122 David Wesley Brock Physician Assistant 3550 N University Ave, Suite 250, Provo, UT 84604-6683 2007-10-04
1255371878 Adam C Phillips Physician Assistant 1034 N 500 W, Provo, UT 84604-3380 2006-06-08
Find all providers in PROVO

Competitor

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City PROVO
Zip Code 84604

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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