Provider Demographics
NPI:1467418947
Name:SEVIGNY, PETER (FNP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SEVIGNY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-7676
Mailing Address - Fax:806-785-7685
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:STE 170
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-744-0566
Practice Address - Fax:806-744-7252
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143762602Medicaid
P30860Medicare UPIN
8D5587Medicare ID - Type Unspecified