Healthcare Provider Details

I. General information

NPI: 1033043757
Provider Name (Legal Business Name): FOG & FERN PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 E MAIN ST STE 8
OLNEY IL
62450-3156
US

IV. Provider business mailing address

7443 E DUNDAS LN
CLAREMONT IL
62421-2110
US

V. Phone/Fax

Practice location:
  • Phone: 618-879-2150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL VOLK
Title or Position: PMHNP-BC
Credential: APRN
Phone: 618-879-2150