Amanda M Eversgerd

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.019216 Issued in IL

Practice address

20 Professional Park Dr
Maryville, IL 62062-5830

Phone

(618) 531-5802

NPI assigned

Apr 4, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1922560101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 FOREST OAKS DR",
            "city": "CASEYVILLE",
            "state": "IL",
            "postal_code": "622322847",
            "telephone_number": "618-531-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PROFESSIONAL PARK DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625830",
            "telephone_number": "618-531-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERSGERD",
        "first_name": "AMANDA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-04",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.019216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Eller
• Jennifer Ellis, LCSW
• Elmwood Nursing & Rehabilitation Center, L.L.C.
• Andrew English, DDS
• Sheena D Eslinger, FNP-BC
• Eye Surgery Center of Maryville LLC
• Eyecare Management LLC
• Abby Fabela
• Fairview Heights Medical Group SC
• Christopher Farrar, M.D.

• Family Nurse Practitioner in Maryville, IL
• Providers in Maryville, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; 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.