Provider Demographics
NPI:1003542127
Name:SEVERSON, DYLAN TRENT (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:TRENT
Last Name:SEVERSON
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 N SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2833
Mailing Address - Country:US
Mailing Address - Phone:316-305-8049
Mailing Address - Fax:
Practice Address - Street 1:340 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2150
Practice Address - Country:US
Practice Address - Phone:913-722-3100
Practice Address - Fax:913-722-2542
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022022667363LF0000X
KS53-81411-011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily