=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033945324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN LYNN BADE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2024
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 E 19TH ST
-----------------------------------------------------
City | CHEYENNE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82001-4646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-374-8271
-----------------------------------------------------
Fax | 307-216-8774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1643 STAR BRIGHT DR
-----------------------------------------------------
City | CHEYENNE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82009-9471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-286-3660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 55303
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------