Provider Demographics
NPI:1538450663
Name:SEVERSON, KIMBERLY LYNN (CD(DONA),CCCE,CBE)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:CD(DONA),CCCE,CBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 WILMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5136
Mailing Address - Country:US
Mailing Address - Phone:321-615-0073
Mailing Address - Fax:
Practice Address - Street 1:2609 WILMETTE AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5136
Practice Address - Country:US
Practice Address - Phone:321-615-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula