Individual provider Active NPI

Jaclyn Gleske, PA-C

  • Physician Assistant
  • Suwanee, GA
National Provider Identifier
1073961850
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13729 Issued in GA
Practice address
1300 Peachtree Industrial Blvd Ste 4101
Suwanee, GA 30024-4542
Phone
(770) 831-5525
NPI assigned
Jun 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13729 GA Primary
Physician Assistant 363A00000X MA063911 PA
Physician Assistant 363A00000X OH

Addresses

Primary practice location

1300 Peachtree Industrial Blvd Ste 4101
Suwanee, GA 30024-4542

Mailing address

1300 Peachtree Industrial Blvd Ste 4101
Suwanee, GA 30024-4542
Phone (770) 831-5525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221222002403 PA Practitioner - Physician Assistant 3870888597 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Jan 16, 2023 Accepting new patients
Geisinger-HM Joint Venture, LLC Physician Assistant CurrentSince Jan 16, 2023 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Jan 16, 2023 Accepting new patients

Locations

224 N Logan Blvd
Burnham, PA 17009
Phone (717) 242-0196

100 N Academy Ave
Danville, PA 17822

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1073961850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD STE 4101",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244542",
            "telephone_number": "770-831-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD STE 4101",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244542",
            "telephone_number": "770-831-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLESKE",
        "first_name": "JACLYN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-02",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13729",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA063911",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

Verify at the official NPI Registry.