TYEISHA WILKINS WITHERSPOON AGPCNP
NPI 1720800600
Nurse Practitioner - Primary Care in Ellicott City, MD
About Tyeisha Wilkins Witherspoon Agpcnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TYEISHA WILKINS WITHERSPOON AGPCNP (NPI 1720800600) is an individual primary care provider in Ellicott City, Maryland, licensed in Maryland (R223487) and active in the NPI registry since October 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).
NPPES Registry Identity
Specialties & Licenses 3
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Tyeisha Wilkins Witherspoon Agpcnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Tyeisha Wilkins Witherspoon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Ellicott City, MD 21042
- Reassigned Medicare billing, Maryland enrollment
- 20 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 21042 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tyeisha Wilkins Witherspoon's NPI number?
The NPI number for Tyeisha Wilkins Witherspoon is 1720800600. It was assigned to this individual provider in the NPPES registry on October 30, 2024.
Where is Tyeisha Wilkins Witherspoon located?
Tyeisha Wilkins Witherspoon practices at 4801 Dorsey Hall Dr Ste 226, Ellicott City, MD 21042. The listed phone number is (410) 997-7660.
What is Tyeisha Wilkins Witherspoon's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Tyeisha Wilkins Witherspoon enrolled in Medicare?
Yes. Tyeisha Wilkins Witherspoon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Tyeisha Wilkins Witherspoon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tyeisha Wilkins Witherspoon reassigns Medicare benefits to Lifebridge Medical Associates, LLC (Ellicott City, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tyeisha Wilkins Witherspoon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Tyeisha Wilkins Witherspoon was last updated on December 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Tyeisha Wilkins Witherspoon, AGPCNP · NPI 1720800600
Primary Care physician in Ellicott City, Maryland. Individual provider, active in the CMS NPPES registry since October 30, 2024.
## Identity
- **NPI:** 1720800600 (Entity type: Individual)
- **Enumerated:** October 30, 2024
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **State license:** R223487 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 4801 DORSEY HALL DR STE 226, Ellicott City, MD 21042-7764
- **Phone:** (410) 997-7660
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Lifebridge Medical Associates, LLC (NPI 1124433628, Ellicott City, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** December 6, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1720800600) · Data from the CMS NPPES public registry.