Healthcare Provider Details

I. General information

NPI: 1508049552
Provider Name (Legal Business Name): AMY LYNN ADAMS APN, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 INGALLS AVE
JOLIET IL
60435-7903
US

IV. Provider business mailing address

4525 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-5201
US

V. Phone/Fax

Practice location:
  • Phone: 815-326-5538
  • Fax:
Mailing address:
  • Phone: 312-857-8794
  • Fax: 708-575-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.000764
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277.000764
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: