Provider Demographics
NPI:1447743257
Name:HOWELL, KORBY JON (PA-C)
Entity type:Individual
Prefix:
First Name:KORBY
Middle Name:JON
Last Name:HOWELL
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 1:401 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROLETTE
Mailing Address - State:ND
Mailing Address - Zip Code:58366
Mailing Address - Country:US
Mailing Address - Phone:701-246-3391
Mailing Address - Fax:701-246-3392
Practice Address - Street 1:401 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROLETTE
Practice Address - State:ND
Practice Address - Zip Code:58366
Practice Address - Country:US
Practice Address - Phone:701-246-3391
Practice Address - Fax:701-246-3392
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant