Provider Demographics
NPI:1679096002
Name:BEYOND PRIMARY CARE, LLC
Entity type:Organization
Organization Name:BEYOND PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHERISE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HAGANS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-412-5093
Mailing Address - Street 1:7700 OLD BRANCH AVE STE E202
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1609
Mailing Address - Country:US
Mailing Address - Phone:240-412-5093
Mailing Address - Fax:402-823-6931
Practice Address - Street 1:7700 OLD BRANCH AVE STE E202
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1609
Practice Address - Country:US
Practice Address - Phone:240-412-5093
Practice Address - Fax:240-238-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD097118900Medicaid