Healthcare Provider Details

I. General information

NPI: 1881632206
Provider Name (Legal Business Name): KIMBERLY A SEVERN C.N.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD SUITE 250
BETHESDA MD
20817-1106
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-9817
  • Fax: 301-897-0832
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR123016
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: