Provider Demographics
NPI:1639520596
Name:SEVERANCE, JENNIFER (DNP, FNP-C, RN)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SEVERANCE
Suffix:
Gender:F
Credentials:DNP, FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-355-9233
Mailing Address - Fax:512-355-9230
Practice Address - Street 1:160 N LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605-4323
Practice Address - Country:US
Practice Address - Phone:512-355-9233
Practice Address - Fax:512-355-9230
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily