Provider Demographics
NPI:1053364299
Name:HOWELL, DEREK L (PA-C)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:L
Last Name:HOWELL
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 1:110 N 29TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4424
Mailing Address - Country:US
Mailing Address - Phone:402-844-8242
Mailing Address - Fax:402-844-8233
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4424
Practice Address - Country:US
Practice Address - Phone:402-844-8242
Practice Address - Fax:402-844-8233
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE863363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES97786Medicare UPIN
NE275134Medicare ID - Type Unspecified