Individual provider Active NPI

Amanda Lee Johnson Fleming, CPNP-PC

  • Pediatric Nurse Practitioner
  • Eden Prairie, MN
National Provider Identifier
1417494998
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
CNP4983 Issued in MN
Practice address
6600 City West Pkwy Ste 200
Eden Prairie, MN 55344-7707
Phone
(612) 356-2756
Fax
(712) 712-9214
NPI assigned
Jan 23, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X CNP4983 MN Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X CNP4983 MN

Addresses

Primary practice location

6600 City West Pkwy Ste 200
Eden Prairie, MN 55344-7707

Mailing address

6600 City West Pkwy Ste 200
Eden Prairie, MN 55344-7707
Phone (612) 356-2756

Other practice location 1

11010 Prairie Lakes Dr
#350
Eden Prairie, MN 55344-3884
Phone (952) 746-2522

Other practice location 2

18562 Minobimaadizi Loop
Onamia, MN 56359-3001
Phone (320) 532-4163

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20170209001026 MN Practitioner - Nurse Practitioner 4587947999 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Master of Arts

State licenses

LicenseStateTypeSpecialty
CNP4983MNMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Feb 27, 2017 Accepting new patients
Mille Lacs Band of Ojibwe Indians Past Accepting new patients
Schneider Psychological & Behavioral Service Psychiatric/Mental Health Past Accepting new patients
Family Support Services Inc. Past Accepting new patients

Locations

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

Interoperability endpoints

  • Direct secure messaging: ajohnsonfleming827876@direct.centracare.com

Organizations & group practices 4

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": "1485129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1417494998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 CITY WEST PKWY STE 200",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447707",
            "telephone_number": "612-356-2756",
            "fax_number": "612-712-9214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 CITY WEST PKWY STE 200",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447707",
            "telephone_number": "612-356-2756",
            "fax_number": "712-712-9214"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11010 Prairie Lakes Dr",
            "address_2": "#350",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "553443884",
            "country_code": "US",
            "telephone_number": "952-746-2522",
            "fax_number": "952-746-0887",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18562 Minobimaadizi Loop",
            "address_purpose": "LOCATION",
            "city": "Onamia",
            "state": "MN",
            "postal_code": "563593001",
            "country_code": "US",
            "telephone_number": "320-532-4163",
            "fax_number": "320-532-7573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON FLEMING",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-23",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "CNP4983",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "CNP4983",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

Verify at the official NPI Registry.