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NPI Code Detail

MEDICARE: RYAN KNOWLTON DO

MEDICARE: RYAN KNOWLTON DO
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
1171000000XMilitary Health Care ProviderSL2401NV
2390200000XStudent in an Organized Health Care Education/Training ProgramSL2401NV

General Provider Information

NPI Number : 1942003579
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN KNOWLTON DO
Provider Business Mailing Address
First Line : 820 RANCHO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3827
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2025
Last Update Date : 03/11/2026

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