Provider Demographics
NPI:1700288958
Name:GLEASON, PATRICK JAMES (APN)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:GLEASON
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 COUNTY ROAD 151
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:WY
Mailing Address - Zip Code:82053-9722
Mailing Address - Country:US
Mailing Address - Phone:307-286-6903
Mailing Address - Fax:
Practice Address - Street 1:1124 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2972
Practice Address - Country:US
Practice Address - Phone:307-746-3700
Practice Address - Fax:307-746-3722
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112740363L00000X
COAPN 0991413-NP363LA2100X
COAPN0991413-NP363LF0000X
WY35871.1415363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily