MEDICARE: KELSEA RAE SEVERSON

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	363L00000X	Nurse Practitioner	R0131794	OK
2	363LA2100X	Acute Care Nurse Practitioner	R0131794	OK

General Provider Information

NPI Number	:	1427807007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEA RAE SEVERSON

Provider Business Mailing Address
First Line	:	341 NE 4TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-4027
Country	:	US
Telephone Number	:	405-693-4493
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 S YALE AVE STE 1210
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-4234
Country	:	US
Telephone Number	:	918-888-5211
Fax Number	:

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

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	03/11/2026

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Directions to “ KELSEA RAE SEVERSON ” Practice Location

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