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NPI Code Detail

MEDICARE: KYLE JOHNSON PA-C

MEDICARE: KYLE JOHNSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant54967CA
2363A00000XPhysician AssistantPA1444NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3V111642OTHERNVSMA MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA1444OTHERNVNV PA LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326480229
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE JOHNSON PA-C
Provider Business Mailing Address
First Line : 3325 RESEARCH WAY
Second Line :
City : CARSON CITY
State : NV
Zip : 89706-7913
Country : US
Telephone Number : 775-888-6610
Fax Number : 775-888-4904
Provider Business Practice Location Address
First Line : 2212 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4124
Country : US
Telephone Number : 702-735-9334
Fax Number : 702-735-9335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2013
Last Update Date : 12/09/2025

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Directions to “ KYLE JOHNSON PA-C” Practice Location

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