Provider Demographics
NPI:1962060848
Name:SIEVERT, SUMMER (PMHNP)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:SIEVERT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 SCOTTSVILLE RD, B2-328
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:386-227-6050
Mailing Address - Fax:386-217-6025
Practice Address - Street 1:1721 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-3030
Practice Address - Country:US
Practice Address - Phone:386-227-6050
Practice Address - Fax:386-217-6025
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014591363LP0808X
FL11004703363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000000000Medicaid