Individual provider Active NPI

Bethany Joy Winfrey Ferguson, FNP-BC

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1235505108
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209-013059 Issued in IL
Practice address
1800 N Knoxville Ave Ste a
Peoria, IL 61603-3005
Phone
(309) 680-7600
Fax
(309) 495-8614
NPI assigned
Aug 14, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209-013059 IL Primary

Addresses

Primary practice location

1800 N Knoxville Ave Ste a
Peoria, IL 61603-3005

Mailing address

2214 N University St
Peoria, IL 61604-3221
Phone (309) 680-7600

Other practice location 1

2321 N Wisconsin Ave
Peoria, IL 61603-5613
Phone (309) 680-7600

Other identifiers 1

IdentifierTypeStateIssuer
209-013059OtherILIL APN LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151021001314 IL Order and Referring Only - Nurse Practitioner 5294044830

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group Past Accepting new patients
Mendota Community Hospital Nurse Practitioner Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1235505108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 N KNOXVILLE AVE STE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033005",
            "telephone_number": "309-680-7600",
            "fax_number": "309-495-8614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2321 N Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616035613",
            "country_code": "US",
            "telephone_number": "309-680-7600",
            "fax_number": "309-681-8620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "BETHANY",
        "middle_name": "JOY WINFREY",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-14",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-013059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL APN LICENSE",
            "identifier": "209-013059",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.