Charisse N Fullwood, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0000000 Issued in NC

Practice address

3200 Blue Ridge Rd Ste 218
Raleigh, NC 27612-8087

Phone

(910) 713-8209

NPI assigned

Oct 29, 2021

Sex

Female

Sole proprietor

Yes

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

Merit-based Incentive Payment System (MIPS)

Final score

98.23 of 100Reported as group

Quality

88.23

Improvement activities

40

Cost

76.47

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pave Behavioral Health Services PC

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1699173294
  Medicare reassignment NPD
• Step Up Care of North Carolina PC

  • Clinical Psychologist
  • Raleigh, NC
  • NPI 1841929395
  Medicare reassignment NPD
• Triad Counseling & Clinical Service LLC

  dba Triad Counseling & Clinical Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greensboro, NC
  • NPI 1619988938
  Medicare reassignment NPD
• Triangle Springs Physician Group, LLC

  • Neurology Physician
  • Raleigh, NC
  • NPI 1063901312
  Medicare reassignment NPD
• A Penny for Your Thoughts, PLLC

  dba Mind & Body Renew Medical Spa and Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Raleigh, NC
  • NPI 1285570994
  NPD Authorized official
• Triangle Springs Physician Group, LLC

  • Neurology Physician
  • Raleigh, NC
  • NPI 1184298408
  NPD (past)

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1154085629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 BLUE RIDGE RD STE 218",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128087",
            "telephone_number": "910-713-8209",
            "fax_number": "833-542-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 BLUE RIDGE RD STE 218",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128087",
            "telephone_number": "910-713-8209"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10901 World Trade Blvd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276174203",
            "country_code": "US",
            "telephone_number": "919-372-4408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLWOOD",
        "first_name": "CHARISSE",
        "middle_name": "N",
        "name_prefix": "Miss",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-29",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "0000000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fuller & Associates I PA (Reflections Dental)
• Alysha Fuller, PT, DPT
• Christi Fuller, LCMHCA
• Elizabeth Fuller, PA
• Ryan Chandler Fuller
• Nyasha Fullwood
• Shannon Ingram Fulmer, CRNA
• Ebony Fulmore
• Britney Shea Fulp, LCSW
• Amanda Fultineer, DPT

• Psychiatric/Mental Health Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; 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.

Verify at the official NPI Registry.