NPIMap

Individual provider Active NPI

Andrea Kishbaugh, FNP-C

  • Family Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1447895891
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5012563 Issued in NC
Practice address
2109 Valleygate Dr Ste 201
Fayetteville, NC 28304-3571
Phone
(910) 486-8880
Fax
(910) 486-8886
NPI assigned
Nov 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5012563 NC Primary

Addresses

Primary practice location

2109 Valleygate Dr Ste 201
Fayetteville, NC 28304-3571

Mailing address

2109 Valleygate Dr Ste 201
Fayetteville, NC 28304-3571
Phone (910) 486-8880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200316002202 NC Practitioner - Nurse Practitioner 3173951662 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Raleigh Neurosurgical Clinic IncGroup PAC ID 1759315500, 52 clinicians
RPK Center for Rehab, Spine and PainGroup PAC ID 0749279438, 4 clinicians

Practice addresses (Care Compare)

110 Turner St
Southern Pines, NC 28387-7053
Phone (910) 725-0361

2109 Valleygate Dr
Suite 201
Fayetteville, NC 28304-3571
Phone (910) 486-8880

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Raleigh Neurosurgical Clinic, Inc. CurrentSince Jul 1, 2025 Accepting new patients
RPK Center for Rehab, Spine & Pain CurrentSince Jan 20, 2020 Accepting new patients
Raleigh Neurosurgical Clinic, Inc. CurrentSince Jul 1, 2025 Accepting new patients

Locations

12610 N Community House Rd
Ste 200
Charlotte, NC 28277
Phone (704) 405-1747

2109 Valleygate Dr
Ste 201
Fayetteville, NC 28304
Phone (910) 486-8880

2605 Hospital Rd
Goldsboro, NC 27534
Phone (919) 741-7502

5838 Six Forks Rd
Ste 100
Raleigh, NC 27609

110 Turner St
Southern Pines, NC 28387
Phone (910) 725-0361

4130 Oleander Dr
Ste 100
Wilmington, NC 28403
Phone (910) 200-5242

Interoperability endpoints

  • Direct secure messaging: akishbaugh583220@directhisp.wakemed.org

Organizations & group practices 3

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1573171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1447895891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 VALLEYGATE DR STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043571",
            "telephone_number": "910-486-8880",
            "fax_number": "910-486-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 VALLEYGATE DR STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043571",
            "telephone_number": "910-486-8880",
            "fax_number": "910-486-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHBAUGH",
        "first_name": "ANDREA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-08",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5012563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.