Healthcare Provider Details

I. General information

NPI: 1780630640
Provider Name (Legal Business Name): BARBARA JEAN SEVERSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBIE JEAN SEVERSON ARNP

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12333 NE 130TH LN SUITE 225
KIRKLAND WA
98034-7467
US

IV. Provider business mailing address

12040 NE 128TH ST MS-10
KIRKLAND WA
98034-3013
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-5350
  • Fax: 425-899-5355
Mailing address:
  • Phone: 425-899-3270
  • Fax: 425-899-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30004455
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: