Provider Demographics
NPI:1851116149
Name:KILONZO, JOHN K (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:KILONZO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-6270
Mailing Address - Fax:775-982-6271
Practice Address - Street 1:75 PRINGLE WAY STE 900
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-982-6270
Practice Address - Fax:775-982-6271
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2025-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPA3177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA3177OtherPAC NUMBER
NV16454624OtherCAQH NUMBER