NPIMap

Individual provider Active NPI

Lisa A Rudisill, MSN FNP C

  • Family Nurse Practitioner
  • Hickory, NC
National Provider Identifier
1881646842
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201668 Issued in NC
Practice address
1771 Tate Blvd SE
Suite 103
Hickory, NC 28602-4249
Phone
(828) 322-1128
Fax
(828) 327-9431
NPI assigned
May 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 092475 NC
Family Nurse Practitioner 363LF0000X 201668 NC Primary

Addresses

Primary practice location

1771 Tate Blvd SE
Suite 103
Hickory, NC 28602-4249

Mailing address

1771 Tate Blvd SE
Suite 103
Hickory, NC 28602-4249
Phone (828) 322-1128

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
I20041008000885 NC Practitioner - Nurse Practitioner 2860451309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1771 Tate Blvd SE
Suite 103
Hickory, NC 28602-4250
Phone (828) 322-1128

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
092475NCMDFamily Nurse Practitioner
201668NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Apr 18, 2016 Accepting new patients
Catawba Valley Medical Center Past Accepting new patients
Catawba Valley Medical Center Past Accepting new patients

Locations

1771 Tate Blvd SE
Ste 103
Hickory, NC 28602
Phone (828) 322-1128

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1881646842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 TATE BLVD SE",
            "address_2": "SUITE 103",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286024249",
            "telephone_number": "828-322-1128",
            "fax_number": "828-327-9431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 TATE BLVD SE",
            "address_2": "SUITE 103",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286024249",
            "telephone_number": "828-322-1128",
            "fax_number": "828-327-9431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDISILL",
        "first_name": "LISA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "MSN FNP C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "092475",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "201668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.