Provider Demographics
NPI:1770101644
Name:GLEESON, KASSIE (FNP-C)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:GLEESON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:
Other - Last Name:HITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1680 HOLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6440
Mailing Address - Country:US
Mailing Address - Phone:770-314-3180
Mailing Address - Fax:
Practice Address - Street 1:1825 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6423
Practice Address - Country:US
Practice Address - Phone:770-502-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily