Provider Demographics
NPI:1033945324
Name:BADE, MEGAN LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:BADE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 STAR BRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-9471
Mailing Address - Country:US
Mailing Address - Phone:307-286-3660
Mailing Address - Fax:
Practice Address - Street 1:611 E CARLSON ST STE 102
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4335
Practice Address - Country:US
Practice Address - Phone:307-316-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY55303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily