Provider Demographics
NPI:1356077796
Name:MCDOWELL, TYSEN CHANE (PA-C)
Entity Type:Individual
Prefix:
First Name:TYSEN
Middle Name:CHANE
Last Name:MCDOWELL
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 1:2605 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4416
Mailing Address - Country:US
Mailing Address - Phone:308-236-7016
Mailing Address - Fax:308-236-7027
Practice Address - Street 1:2605 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4416
Practice Address - Country:US
Practice Address - Phone:308-236-7016
Practice Address - Fax:308-236-7027
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant