Healthcare Provider Details

I. General information

NPI: 1871447193
Provider Name (Legal Business Name): NEVIN ABRAHAM MATHEW PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W BRADLEY AVE
PEORIA IL
61625-0001
US

IV. Provider business mailing address

1501 W BRADLEY AVE
PEORIA IL
61625-0001
US

V. Phone/Fax

Practice location:
  • Phone: 847-668-1567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.035050
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041.513336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: