Provider Demographics
NPI:1356682637
Name:BEADLE, MEGAN C (PA)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:C
Last Name:BEADLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:C
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:130 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2246
Mailing Address - Country:US
Mailing Address - Phone:970-641-0211
Mailing Address - Fax:970-641-1268
Practice Address - Street 1:130 E VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2246
Practice Address - Country:US
Practice Address - Phone:970-641-0211
Practice Address - Fax:970-641-1268
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22874363AM0700X
CO3861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3861OtherPA
CAPA22874OtherPA LICENSE
CO04013918Medicaid