Active NPI
Bethany Johnson, FNP-BC
- Nurse Practitioner
- Fargo, ND
National Provider Identifier
1104751320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 205339
- Practice address
- 801 Broadway N
Fargo, ND 58102-3641 - Phone
- (701) 234-2251
- NPI assigned
- Jun 17, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 205339 | ND | |
| Nurse Practitioner | 363L00000X | 205339 | ND | Primary |
Addresses
Primary practice location
801 Broadway N
Fargo, ND 58102-3641
Mailing address
5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2000
Other practice location 1
801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000
Other practice location 2
5225 23rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2000
Other names 1
- Bethany Sandy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1781654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783382400000",
"number": "1104751320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5225 23RD AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581047927",
"telephone_number": "701-417-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581023641",
"telephone_number": "701-234-2251"
}
],
"practiceLocations": [
{
"address_1": "801 Broadway N",
"address_purpose": "LOCATION",
"city": "Fargo",
"state": "ND",
"postal_code": "581023641",
"country_code": "US",
"telephone_number": "701-234-2000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5225 23rd Ave S",
"address_purpose": "LOCATION",
"city": "Fargo",
"state": "ND",
"postal_code": "581047927",
"country_code": "US",
"telephone_number": "701-417-2000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "BETHANY",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-06-17",
"last_updated": "2026-07-07",
"certification_date": "2026-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ND",
"license": "205339",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "ND",
"license": "205339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BETHANY",
"last_name": "SANDY",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.