Provider Demographics
NPI:1932508819
Name:SEVERSON, KATHRYN (APN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:APN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VINEYARD WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8849
Mailing Address - Country:US
Mailing Address - Phone:610-444-7550
Mailing Address - Fax:610-444-4656
Practice Address - Street 1:105 VINEYARD WAY STE 200
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390
Practice Address - Country:US
Practice Address - Phone:610-444-7550
Practice Address - Fax:610-444-4656
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0043433163W00000X
DELH-0000209363LW0102X
390200000X
PASP017509363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103520849Medicaid