TISA L MITCHELL-FULLWOOD FNP
NPI 1053832717
Nurse Practitioner - Family in Cary, NC

Q: What is Tisa Mitchell-fullwood's NPI number?

The NPI number for Tisa Mitchell-fullwood is 1053832717. It was assigned to this individual provider in the NPPES registry on July 3, 2017.

Q: What is Tisa Mitchell-fullwood's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since July 03, 2017PECOS Enrolled

2994 KILDAIRE FARM RD, CARY, NC 27518(919) 387-1075 Get Directions Write a Review

NPPES record last updated: August 31, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 31, 2022, Jul 26, 2022, Jul 3, 2017 (3 updates tracked since 2017).

On this page

About Tisa L Mitchell-fullwood Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TISA L MITCHELL-FULLWOOD FNP (NPI 1053832717) is an individual family provider in Cary, North Carolina, licensed in North Carolina (5010016) and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053832717

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameTISA L MITCHELL-FULLWOODCredential: FNP

Location Address2994 KILDAIRE FARM RDCary, NC 27518-9614

Mailing Address2994 Kildaire Farm RdCary, NC 27518-9614 · (919) 387-1075

Phone(919) 387-1075

Sole ProprietorNo

Enumeration DateJuly 3, 2017

Last NPPES UpdateAugust 31, 20223 updates tracked since enumeration

NPPES CertifiedAugust 31, 2022

✔ NPI 1053832717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in NC · 5010016

2994 KILDAIRE FARM RD, Cary, NC 27518

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tisa L Mitchell-fullwood Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27518 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$95.94 typical visit price

range $17.21 – $134.61

Typical copayment $23.98 (range $4.30 – $33.65)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Leave this field empty

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. EMILY RIDGELY MCCREA

Nurse Practitioner (Family)