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General NPI Number Information
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NPI Number | 1053103796
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Entity Type | Organization
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Legal Business Name | BEACH PRIMARY CARE AND WELLNESS PLLC
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 863 OCEAN HWY W
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City | SUPPLY
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State | NC
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Zip | 28462-4059
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Country | US
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Telephone | 910-995-7022
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 STONE BALLAST WAY SW
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City | OCEAN ISLE BEACH
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State | NC
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Zip | 28469-6537
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Country | US
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Telephone | 910-995-7022
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | DR. MARY RUDD CRICHTON
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Credential | DNP
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Telephone | 910-995-7022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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