Provider Demographics
NPI:1922720689
Name:SEVERINSEN, KAYLA (NP)
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:
Last Name:SEVERINSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4228
Mailing Address - Country:US
Mailing Address - Phone:847-508-0499
Mailing Address - Fax:
Practice Address - Street 1:1325 REMINGTON RD STE X
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4815
Practice Address - Country:US
Practice Address - Phone:630-237-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty