Provider Demographics
NPI:1124793401
Name:SEVERSON, KAYLAN TILLIE (RN)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:TILLIE
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAYLAN
Other - Middle Name:TILLIE
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1106 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-6218
Mailing Address - Country:US
Mailing Address - Phone:402-414-2090
Mailing Address - Fax:
Practice Address - Street 1:8314 BOYD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4224
Practice Address - Country:US
Practice Address - Phone:531-299-1141
Practice Address - Fax:531-299-1158
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE91517163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool