Provider Demographics
NPI:1073376950
Name:BEAUREGARD, RENEE (MSN, PMHNP-BC, RN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BEAUREGARD
Suffix:
Gender:
Credentials:MSN, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MOCKINGBIRD LN STE 420
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3236
Mailing Address - Country:US
Mailing Address - Phone:717-870-9303
Mailing Address - Fax:
Practice Address - Street 1:329 SILVER GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-6978
Practice Address - Country:US
Practice Address - Phone:910-208-0048
Practice Address - Fax:704-703-9668
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790572303OtherNPI