Healthcare Provider Details

I. General information

NPI: 1629905443
Provider Name (Legal Business Name): DARRYL DELWIN CORNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 S 13TH ST
LINCOLN NE
68502-4515
US

IV. Provider business mailing address

3105 S 13TH ST
LINCOLN NE
68502-4515
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-0311
  • Fax:
Mailing address:
  • Phone: 402-742-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberH13987855
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: