Active NPI
Tricia M Fossum, NP
- Nurse Practitioner
- Fargo, ND
National Provider Identifier
1629099858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R25993
- Practice address
- 737 Broadway N
Fargo, ND 58122-0001 - Phone
- (701) 234-4811
- Fax
- (701) 234-6979
- NPI assigned
- Jul 22, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R25993 | ND | Primary |
Addresses
Primary practice location
737 Broadway N
Fargo, ND 58122-0001
Mailing address
737 Broadway
Fargo, ND 58122-0001
Phone (701) 234-6236
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R25993 | ND | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629099858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "737 BROADWAY",
"city": "FARGO",
"state": "ND",
"postal_code": "581220001",
"telephone_number": "701-234-6236",
"fax_number": "701-234-7332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "737 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581220001",
"telephone_number": "701-234-4811",
"fax_number": "701-234-6979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSSUM",
"first_name": "TRICIA",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "ND",
"license": "R25993",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 8, 2007; 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.