Healthcare Provider Details

I. General information

NPI: 1730906637
Provider Name (Legal Business Name): BEYOND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 VOLUNTEER BLVD STE 100
HENDERSON NV
89044-1857
US

IV. Provider business mailing address

PO BOX 401477
LAS VEGAS NV
89140-1477
US

V. Phone/Fax

Practice location:
  • Phone: 833-759-8720
  • Fax: 833-438-5615
Mailing address:
  • Phone: 833-759-8720
  • Fax: 833-973-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 833-759-8720