Organization Active NPI

Divine Design Psychiatry and Wellness PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • O Fallon, IL
National Provider Identifier
1104779750
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DIVINE DESIGN PSYCHIATRY AND WELLNESS PLLC
Practice address
853 Chesapeake Junction LN
O Fallon, IL 62269-7035
Phone
(217) 816-7928
Fax
(616) 208-2675
NPI assigned
Feb 16, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Authorized official

Name
Angela Severado, FNP/PMHNPNPI 1952787376
Title
Nurse Practitioner/Owner
Phone
(217) 816-7928

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

853 Chesapeake Junction LN
O Fallon, IL 62269-7035

Mailing address

853 Chesapeake Junction LN
O Fallon, IL 62269-7035
Phone (217) 816-7928

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1771200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1104779750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 CHESAPEAKE JUNCTION LN",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697035",
            "telephone_number": "217-816-7928",
            "fax_number": "616-208-2675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 CHESAPEAKE JUNCTION LN",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697035",
            "telephone_number": "217-816-7928",
            "fax_number": "616-208-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE DESIGN PSYCHIATRY AND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-16",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "SEVERADO",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "217-816-7928",
        "authorized_official_credential": "FNP/PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.