Provider Demographics
NPI:1407540099
Name:GLEASON, KAYLA RENAE (LPN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENAE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RENAE
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:325 WELLS JONES RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9626
Mailing Address - Country:US
Mailing Address - Phone:740-222-4841
Mailing Address - Fax:
Practice Address - Street 1:325 WELLS JONES RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9626
Practice Address - Country:US
Practice Address - Phone:740-222-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184051164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse