=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376187427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY EVERHART PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2019
-----------------------------------------------------
Last Update Date | 11/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 PARK MEADOW RD STE 203
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-2877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-820-1091
-----------------------------------------------------
Fax | 614-585-8544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1841 S 3 BS AND K RD
-----------------------------------------------------
City | GALENA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43021-9242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-815-4195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0029688
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------