Provider Demographics
NPI:1053103796
Name:BEACH PRIMARY CARE AND WELLNESS PLLC
Entity type:Organization
Organization Name:BEACH PRIMARY CARE AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RUDD
Authorized Official - Last Name:CRICHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:910-995-7022
Mailing Address - Street 1:1920 STONE BALLAST WAY SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-6537
Mailing Address - Country:US
Mailing Address - Phone:910-995-7022
Mailing Address - Fax:
Practice Address - Street 1:863 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4059
Practice Address - Country:US
Practice Address - Phone:910-995-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care