Healthcare Provider Details

I. General information

NPI: 1356682637
Provider Name (Legal Business Name): MEGAN C BEADLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGAN C HENSLEY PA

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST STE 506
LINCOLN NE
68506-1225
US

IV. Provider business mailing address

1500 S 48TH ST STE 506
LINCOLN NE
68506-1225
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-1110
  • Fax: 402-489-8492
Mailing address:
  • Phone: 402-489-1110
  • Fax: 402-489-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3089
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3861
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: