Provider Demographics
NPI:1740266568
Name:JOHNS, PAUL (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:JOHNS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 RYLAND ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1603
Mailing Address - Country:US
Mailing Address - Phone:775-329-4600
Mailing Address - Fax:775-333-2969
Practice Address - Street 1:880 RYLAND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1603
Practice Address - Country:US
Practice Address - Phone:775-329-4600
Practice Address - Fax:775-333-2969
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504166Medicaid
NV40220Medicare ID - Type Unspecified
NV100504166Medicaid