Individual provider Active NPI

Nicholas Aaron Kilgore, PA-C

  • Physician Assistant
  • Twentynine Palms, CA
National Provider Identifier
1205356433
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1145 Sturgis Rd
Twentynine Palms, CA 92278
Phone
(760) 830-2190
NPI assigned
Jun 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Independent Duty Corpsman 1710I1002X

Addresses

Primary practice location

1145 Sturgis Rd
Twentynine Palms, CA 92278

Mailing address

3302A Fuller St
Twentynine Palms, CA 92277-9435
Phone (757) 817-3035

Other practice location 1

34800 Bob Wilson Dr
San Diego, CA 92134-1098
Phone (619) 532-6400

Other practice location 2

472 Polaris St Bldg 586
Virginia Beach, VA 23461-1935
Phone (757) 862-9999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1205356433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3302A FULLER ST",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922779435",
            "telephone_number": "757-817-3035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 STURGIS RD",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "92278",
            "telephone_number": "760-830-2190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34800 Bob Wilson Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921341098",
            "country_code": "US",
            "telephone_number": "619-532-6400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "472 Polaris St Bldg 586",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234611935",
            "country_code": "US",
            "telephone_number": "757-862-9999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILGORE",
        "first_name": "NICHOLAS",
        "middle_name": "AARON",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-20",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twentynine Palms, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.