Provider Demographics
NPI:1972055291
Name:SEVERNS, GEORGIA (LPN)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:SEVERNS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:SEVERNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:705 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2926
Mailing Address - Country:US
Mailing Address - Phone:816-581-5889
Mailing Address - Fax:816-347-3046
Practice Address - Street 1:901 NE INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5544
Practice Address - Country:US
Practice Address - Phone:816-581-5889
Practice Address - Fax:816-347-3046
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003006875164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse