Individual
KELSEY GLEASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1055 N 500 W STE 121, PROVO, UT 84604
(801) 373-7350
(801) 812-5401
Mailing address
1055 N 500 W, ATT: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11085884-1206
UT
363AS0400X
Surgical Physician Assistant
Primary
11085884-1206
UT
Other
Enumeration date
06/09/2015
Last updated
11/27/2023
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