Healthcare Provider Details

I. General information

NPI: 1295679330
Provider Name (Legal Business Name): CHIX BEACH MEDICAL AND WELLNESS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 VIRGINIA BEACH BLVD STE 104
VIRGINIA BEACH VA
23462-5687
US

IV. Provider business mailing address

3934 AERIES WAY
VIRGINIA BEACH VA
23455-1552
US

V. Phone/Fax

Practice location:
  • Phone: 757-770-3444
  • Fax: 757-208-1378
Mailing address:
  • Phone: 757-770-3444
  • Fax: 757-208-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELINA S REYNOLDS
Title or Position: OWNER, NURSE PRACTITIONER
Credential: AGPCNP-C
Phone: 757-770-3444