Provider Demographics
NPI:1356682637
Name:BEADLE, MEGAN C (PA-C)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:C
Last Name:BEADLE
Suffix:
Gender:F
Credentials:PA-C
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 1:1500 S 48TH ST
Mailing Address - Street 2:STE 506
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1225
Mailing Address - Country:US
Mailing Address - Phone:402-489-1110
Mailing Address - Fax:402-489-8492
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:STE 506
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1225
Practice Address - Country:US
Practice Address - Phone:402-489-1110
Practice Address - Fax:402-489-8492
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3089363A00000X
CO3861363A00000X
CAPA22874363AM0700X
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