Healthcare Provider Details

I. General information

NPI: 1588520118
Provider Name (Legal Business Name): MARY ELIZABETH MYERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 AUTUMN LN
MURRAY NE
68409-3003
US

IV. Provider business mailing address

8206 AUTUMN LN
MURRAY NE
68409-3003
US

V. Phone/Fax

Practice location:
  • Phone: 618-334-2915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberIN-PROCESS
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: