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: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 AUTUMN LN
MURRAY NE
68409-3003
US

IV. Provider business mailing address

PO BOX 22359
LINCOLN NE
68542-2359
US

V. Phone/Fax

Practice location:
  • Phone: 618-334-2915
  • Fax:
Mailing address:
  • Phone: 402-802-2681
  • Fax: 888-658-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3365
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: