Amy Nicole Evermon, M.S.ED

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

750 Broadway Ave E
Mattoon, IL 61938-4610

Phone

(217) 238-5700

Fax

(217) 238-5767

NPI assigned

Dec 22, 2005

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

Other names 1

• Miss Amy Nicole Brault Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Coles County Mental Health Association, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mattoon, IL
  • NPI 1942203914
  Medicare reassignment NPD
• Coles County Mental Health Association, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Effingham, IL
  • NPI 1841738283
  NPD
• Coles County Mental Health Association, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mattoon, IL
  • NPI 1184393118
  NPD (past)

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195603200000",
    "number": "1962488783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 BROADWAY AVE E",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384610",
            "telephone_number": "217-238-5700",
            "fax_number": "217-238-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 BROADWAY AVE E",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384610",
            "telephone_number": "217-238-5700",
            "fax_number": "217-238-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERMON",
        "first_name": "AMY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "M.S.ED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-22",
        "last_updated": "2007-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "BRAULT",
            "middle_name": "NICOLE",
            "prefix": "MISS",
            "credential": "M.S.ED",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karie Erickson
• Alesha Esker, OTR/L
• Barbara E Estes, M.S.
• Sandra Lynn Ettema, M.D., PH.D.
• Jessica Marie Evans, BS
• Julie Evilsizer, PTA
• Family Home Care, Inc.
• Kathleen Farrell, BA
• Joanna Faught
• Paul William Fearday, BA MHP

• Counselor in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.

Verify at the official NPI Registry.