=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295679330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIX BEACH MEDICAL AND WELLNESS CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2026
-----------------------------------------------------
Last Update Date | 04/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5650 VIRGINIA BEACH BLVD STE 104
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-5687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-770-3444
-----------------------------------------------------
Fax | 757-208-1378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3934 AERIES WAY
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23455-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-770-3444
-----------------------------------------------------
Fax | 757-208-1378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. ELINA S REYNOLDS
-----------------------------------------------------
Credential | AGPCNP-C
-----------------------------------------------------
Telephone | 757-770-3444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------