Active NPI
Lisa Dawn Fetters, NP
- Physician Assistant
- Norfolk, VA
National Provider Identifier
1104254473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110004274
- Practice address
- 150 Kingsley LN
Norfolk, VA 23505-4602 - Phone
- (757) 484-5900
- Fax
- (757) 483-3371
- NPI assigned
- Oct 24, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110004274 | VA | Primary |
Addresses
Primary practice location
150 Kingsley LN
Norfolk, VA 23505-4602
Mailing address
150 Kingsley LN
Norfolk, VA 23505-4602
Phone (757) 484-5900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Eastern Virginia Medical School, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
4053 Taylor Rd
Suite K
Chesapeake, VA 23321-5526
Phone (757) 483-6401
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| First Care Collaborative PLLC | Past | Accepting new patients |
Interoperability endpoints
- lisafetters@fcpc.allscriptsdirect.net
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Chesapeake, VA
- NPI 1366553364
-
- Family Medicine Physician
- Chesapeake, VA
- NPI 1770190191
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Virginia Beach, VA
- NPI 1003265075
-
- General Acute Care Hospital
- Chesapeake, VA
- NPI 1700896354
-
- Home Health Agency
- Suffolk, VA
- NPI 1508684457
-
- General Acute Care Hospital
- Suffolk, VA
- NPI 1104658434
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383696000000",
"number": "1104254473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 KINGSLEY LN",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235054602",
"telephone_number": "757-484-5900",
"fax_number": "757-483-3371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 KINGSLEY LN",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235054602",
"telephone_number": "757-484-5900",
"fax_number": "757-483-3371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTERS",
"first_name": "LISA",
"middle_name": "DAWN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-24",
"last_updated": "2013-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110004274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.