LISA DAWN FETTERS (NP) – Physician Assistant, NPI 1104254473

LISA DAWN FETTERS (NP) is a healthcare provider. based in Norfolk, Virginia. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials NP. They hold a License No. 0110004274 (VA). The NPI Number for LISA DAWN FETTERS (NP) is 1104254473

Main info

Female
13 Years Of Experience
Accepts Medicare Assignment
Name
LISA DAWN FETTERS (NP)
NPI
1104254473
Phone
(757) 484-5900
Address
150 KINGSLEY LN
Enumeration Date
24 October 2013
Last Update Date
6 November 2013

Doctor Profile

Medical School Name
EASTERN VIRGINIA MEDICAL SCHOOL
Secondary Phone
7574836401
Graduation Year
2013 (13 years ago)
PAC ID
7416184262
Group Practice PAC ID
1557351939
Professional Enrollment ID
I20131226000882
Address ID
VA233215526CH4053XRDXX305
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience38
Completeness75
Years active:12State licenses:1Digital endpointsOther names

4,429 PHYSICIAN ASSISTANT in VA

Provider Addresses for LISA DAWN FETTERS (NP)

  • 150 KINGSLEY LN

    NORFOLK, VA 235054602

    Phone: (757) 484-5900

    Fax: (757) 483-3371

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 72 Open Payments records for all available years, with a total value of $1,310.

Total Amount is formed as General ($1,310) + Research ($0) + Ownership ($0) = $1,310.

Last reported payment date: 2024-12-17 • Largest payer in this snapshot: AstraZeneca Pharmaceuticals LP ($387).

Total Amount

$1,310

General + Research + Ownership

Payments

72

Total payment records

General Amount

$1,310

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-17

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2013-12-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20131226000882IPhysician AssistantVATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 23505)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1557351939View full group profile
NameSpecialtyState
Nurse PractitionerVA
Nurse PractitionerVA
-VA
Nurse PractitionerVA
Internal MedicineVA
-VA
Family PracticeVA
Family Practice, Emergency MedicineVA

Reviews

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Frequently asked questions

Can I verify LISA DAWN FETTERS (NP) with an NPI only?
You can start verification with NPI 1104254473 for LISA DAWN FETTERS (NP), then check state licensing separately.
Does CMS list LISA DAWN FETTERS (NP) as active?
Yes — LISA DAWN FETTERS (NP) is active in the NPI listing used on this page.
What taxonomy line describes LISA DAWN FETTERS (NP)?
For research purposes, treat LISA DAWN FETTERS (NP) as Physician Assistant in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for LISA DAWN FETTERS (NP)?
LISA DAWN FETTERS (NP)'s geographic hint is Norfolk, Virginia in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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