Tyeisha Wilkins Witherspoon, AGPCNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

R223487 Issued in MD

Practice address

4801 Dorsey Hall Dr Ste 226
Ellicott City, MD 21042-7764

Phone

(410) 997-7660

NPI assigned

Oct 30, 2024

Last updated

Dec 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lifebridge Medical Associates LLCGroup PAC ID 0446470165, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifebridge Medical Associates, LLC

  dba Crossroads Medical Group

  • Internal Medicine Physician
  • Ellicott City, MD
  • NPI 1124433628
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1720800600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 GRANITE RD",
            "city": "WOODSTOCK",
            "state": "MD",
            "postal_code": "211631005",
            "telephone_number": "410-493-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR STE 226",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427764",
            "telephone_number": "410-997-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINS WITHERSPOON",
        "first_name": "TYEISHA",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R223487",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MD",
            "license": "R223487",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "R223487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Joy Whorton, LCSW-C
• Robert J Wicks, PSY.D
• Dina Wieczynski
• Melissa Wiedel
• Mark Wilkerson, PH.D
• Florica Willard, LCMFT
• Adolphus Williams
• Cicely Williams
• Jannel Jessi Williams
• Lauren Keane Williams, LCSW-C

• Primary Care Nurse Practitioner in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Primary Care Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; 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.