Provider Demographics
NPI:1144332933
Name:FOWLER, CASEY E (PA-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:E
Last Name:FOWLER
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 1:215 MCNEEL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6054
Mailing Address - Country:US
Mailing Address - Phone:308-534-6655
Mailing Address - Fax:308-534-6662
Practice Address - Street 1:215 MCNEEL LN
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6054
Practice Address - Country:US
Practice Address - Phone:308-534-6655
Practice Address - Fax:308-534-6662
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE273714OtherMEDICARE
NE47076161613Medicaid
NE0351020001Medicare NSC
NE47076161613Medicaid