Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mary Alexis Tully, PA-C

Individual provider Medical Physician Assistant · NPI 1790563211

Mary Alexis Tully, PA-C is a Physician Assistant in Wilmington, North Carolina. Qualified in 2023, 3 years ago. Practices with Novant Health Medical Group Coastal Region LLC, a 576-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
3
Licensed in
NC
In the registry since
2023
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2131 S 17th St
Wilmington, NC 28401-7407
Phone: (910) 667-7000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-13667 (NC)
Medical Physician Assistant Taxonomy 363AM0700X (NC)

Record details

NPI number1790563211
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 18, 2023
Last updated in NPPESJuly 29, 2024
Certification dateJuly 29, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Novant Health Medical Group Coastal Region Llc — 576 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Wilmington