Provider Demographics
NPI:1790788511
Name:SEWELL, DENNIS L (PA-C)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:SEWELL
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 1:1100 HIGHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901
Mailing Address - Country:US
Mailing Address - Phone:785-243-1234
Mailing Address - Fax:785-243-8411
Practice Address - Street 1:1100 HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901
Practice Address - Country:US
Practice Address - Phone:785-243-1234
Practice Address - Fax:785-243-8411
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200006380FMedicaid
KS200006380BMedicaid
KS12311OtherPREFERED HEALTH WICHITA
KS427053OtherABILENE BCBS
KS200006380AMedicaid