Provider Demographics
NPI:1912006008
Name:POWELL, DAVID J (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:POWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 E H ST
Mailing Address - Street 2:PO BOX 1207
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3589
Mailing Address - Country:US
Mailing Address - Phone:308-344-4110
Mailing Address - Fax:308-344-8369
Practice Address - Street 1:1401 E H ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3589
Practice Address - Country:US
Practice Address - Phone:308-344-4110
Practice Address - Fax:308-344-8369
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant