MEDICARE: KRISTY MARIE SEVERSON NP

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	363LA2200X	Adult Health Nurse Practitioner	APN.0990373-NP	CO
2	364SM0705X	Medical-Surgical Clinical Nurse Specialist	R152551-3	MN
3	363LF0000X	Family Nurse Practitioner	APN.0990373-NP	CO
4	363LA2100X	Acute Care Nurse Practitioner	APN.0990373-NP	CO
5	363LA2200X	Adult Health Nurse Practitioner	APRN11043063	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XQ296	OTHER	FL	HFMG

General Provider Information

NPI Number	:	1861569998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY MARIE SEVERSON NP

Provider Business Mailing Address
First Line	:	PO BOX 110429
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80042-0429
Country	:	US
Telephone Number	:	303-493-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 GATEWAY DR STE 2B
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2607
Country	:	US
Telephone Number	:	321-407-7097
Fax Number	:	321-600-2012

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/18/2026

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