Active NPI
Jessica Anne Fashant-Peterson, CNP
- Family Medicine Physician
- Eden Prairie, MN
National Provider Identifier
1609109982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R161940-3
- Practice address
- 6452 City West Pkwy
Eden Prairie, MN 55344-3245 - Phone
- (952) 999-0333
- Fax
- (952) 300-2558
- NPI assigned
- Sep 17, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R161940-3 | MN | Primary |
Addresses
Primary practice location
6452 City West Pkwy
Eden Prairie, MN 55344-3245
Mailing address
6452 City West Parkway
Eden Prairie, MN 55344
Phone (952) 999-0333
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
- Opted out of Medicare
- Yes, effective Mar 3, 2026 through Mar 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R161940-3 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1495411200000",
"number": "1609109982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6452 CITY WEST PARKWAY",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "55344",
"telephone_number": "952-999-0333",
"fax_number": "952-300-2558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6452 CITY WEST PKWY",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443245",
"telephone_number": "952-999-0333",
"fax_number": "952-300-2558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FASHANT-PETERSON",
"first_name": "JESSICA",
"middle_name": "ANNE",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-17",
"last_updated": "2017-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "R161940-3",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2017; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.