Provider Demographics
NPI:1376015495
Name:BEETS, MEGAN LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LOUISE
Last Name:BEETS
Suffix:
Gender:F
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 1:10500 HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:GUSTON
Mailing Address - State:KY
Mailing Address - Zip Code:40142-7135
Mailing Address - Country:US
Mailing Address - Phone:270-750-0021
Mailing Address - Fax:
Practice Address - Street 1:107 CRANES ROOST CT
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3650
Practice Address - Country:US
Practice Address - Phone:270-765-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant