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 1:715 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4497
Mailing Address - Country:US
Mailing Address - Phone:402-463-4521
Mailing Address - Fax:
Practice Address - Street 1:715 N SAINT JOSEPH AVE
Practice Address - Street 2:STE 106
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4422
Practice Address - Country:US
Practice Address - Phone:402-462-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant