Provider Demographics
NPI:1073376950
Name:BEAUREGARD, RENEE (MSN, PMHNP-BC, CEN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BEAUREGARD
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 AZURE LN APT 108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-7034
Mailing Address - Country:US
Mailing Address - Phone:717-870-9303
Mailing Address - Fax:
Practice Address - Street 1:3825 MARKET ST STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1426
Practice Address - Country:US
Practice Address - Phone:910-777-5575
Practice Address - Fax:910-777-5273
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health