Healthcare Provider Details

I. General information

NPI: 1629773361
Provider Name (Legal Business Name): SAMUEL CLAYTON COREY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42ND AND EMILE ST
OMAHA NE
68198-0001
US

IV. Provider business mailing address

2271 350TH ST
LAKE CITY IA
51449-7526
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2000
  • Fax:
Mailing address:
  • Phone: 712-210-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3136
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number03543901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: