Beyond the Body Wellness LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

BEYOND THE BODY WELLNESS LLC

Practice address

1121 Homestead Rd N Ste 279
Lehigh Acres, FL 33936-6038

Phone

(765) 432-7195

NPI assigned

Mar 14, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dedra D Coop, NP

Title

NP/President

Phone

(765) 432-7195

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1194473751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 HOMESTEAD RD N STE 279",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339366038",
            "telephone_number": "765-432-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 HOMESTEAD RD N STE 279",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339366038",
            "telephone_number": "765-432-7195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4403 E 19th St",
            "address_purpose": "LOCATION",
            "city": "Lehigh Acres",
            "state": "FL",
            "postal_code": "339721400",
            "country_code": "US",
            "telephone_number": "765-432-7195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEYOND THE BODY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-02-28",
        "status": "A",
        "authorized_official_last_name": "COOP",
        "authorized_official_first_name": "DEDRA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "NP/PRESIDENT",
        "authorized_official_telephone_number": "765-432-7195",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lehigh Acres, FL
• Primary Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.