Provider Demographics
NPI:1467423244
Name:GLEUE, PATRICIA A (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GLEUE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11257 S AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:KS
Mailing Address - Zip Code:66414-9257
Mailing Address - Country:US
Mailing Address - Phone:785-554-5284
Mailing Address - Fax:
Practice Address - Street 1:5040 SW 28TH ST STE B
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2302
Practice Address - Country:US
Practice Address - Phone:785-554-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74803364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097940AMedicaid
KS160903Medicare ID - Type Unspecified