MEDICARE: KAITLYN NICOLE SEVERSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1952266355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN NICOLE SEVERSON PA-C

Provider Business Mailing Address
First Line	:	2769 HEARTLAND DR STE 303
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2732
Country	:	US
Telephone Number	:	319-500-8051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2769 HEARTLAND DR STE 303
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2732
Country	:	US
Telephone Number	:	319-500-8051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	02/12/2026

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Directions to “ KAITLYN NICOLE SEVERSON PA-C” Practice Location

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