Provider Demographics
NPI:1902801616
Name:SEVERSON, KATHARINE ADELE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ADELE
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 STOPE CT
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8333
Mailing Address - Country:US
Mailing Address - Phone:530-642-1787
Mailing Address - Fax:
Practice Address - Street 1:899 SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4437
Practice Address - Country:US
Practice Address - Phone:530-621-3600
Practice Address - Fax:530-621-3668
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 8714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP 34585Medicare UPIN