Provider Demographics
NPI:1164768248
Name:VOLKERS, KATIE SEVERANCE (RN, ACNS-BC, CNRN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SEVERANCE
Last Name:VOLKERS
Suffix:
Gender:F
Credentials:RN, ACNS-BC, CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 15TH ST
Mailing Address - Street 2:CEC SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1930
Mailing Address - Country:US
Mailing Address - Phone:512-487-4699
Mailing Address - Fax:
Practice Address - Street 1:601 E 15TH ST
Practice Address - Street 2:CEC SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1930
Practice Address - Country:US
Practice Address - Phone:512-487-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776720364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326118201Medicaid
TX326118201Medicaid