Provider Demographics
NPI:1922832724
Name:KHO, JENNILEE (PA)
Entity type:Individual
Prefix:
First Name:JENNILEE
Middle Name:
Last Name:KHO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 AVALON CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-2076
Mailing Address - Country:US
Mailing Address - Phone:206-794-2559
Mailing Address - Fax:
Practice Address - Street 1:2711 AVALON CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-2076
Practice Address - Country:US
Practice Address - Phone:206-794-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical