Tisa L Mitchell-Fullwood, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5010016 Issued in NC

Practice address

2994 Kildaire Farm Rd
Cary, NC 27518-9614

Phone

(919) 387-1075

NPI assigned

Jul 3, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: tisa.fullwood.1@15189.direct.athenahealth.com

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1053832717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2994 KILDAIRE FARM RD",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275189614",
            "telephone_number": "919-387-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2994 KILDAIRE FARM RD",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275189614",
            "telephone_number": "919-387-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL-FULLWOOD",
        "first_name": "TISA",
        "middle_name": "L",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-03",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5010016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kanique Shanta Miree, LMBT
• Mahidhar Miriyala
• Ramuel Miro
• Deeksha Mishra
• Allison Mistler
• Victoria M Mitchell-Moss
• Anthony Mitchell
• Blayke Mitchell, RBT
• Briania Makaela Mitchell
• Brianna Mitchell, DPT

• Family Nurse Practitioner in Cary, NC
• Providers in Cary, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.