Individual
JONATHAN L. KILSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
933 E PIERCE ST, COUNCIL BLUFFS, IA 51503-4626
(712) 396-6111
(712) 396-7026
Mailing address
PO BOX 2797, OMAHA, NE 68103-2797
(402) 354-4230
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
081384
IA
363A00000X
Physician Assistant
PA09172
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740695899
—
IA
05
—
420680355-12
—
NE
Enumeration date
06/27/2014
Last updated
10/02/2019
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