Provider Demographics
NPI:1780630640
Name:SEVERSON, BARBARA JEAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JEAN
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:BOBBIE
Other - Middle Name:JEAN
Other - Last Name:SEVERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:12040 NE 128TH ST
Mailing Address - Street 2:MS-10
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-3270
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:SUITE 225
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-899-5350
Practice Address - Fax:425-899-5355
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004455363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1233SEOtherBLUE SHIELD
AKNP3100WMedicaid
WA9621350Medicaid
WA213265OtherLABOR & INDUSTRIES
WA1233SEOtherBLUE SHIELD
WAG8863832Medicare PIN