Healthcare Provider Details

I. General information

NPI: 1548106073
Provider Name (Legal Business Name): KYRA GRACE GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PINE TREE DR
ARDEN HILLS MN
55112-3754
US

IV. Provider business mailing address

7570 32ND ST N APT 306
OAKDALE MN
55128-4059
US

V. Phone/Fax

Practice location:
  • Phone: 762-772-4120
  • Fax:
Mailing address:
  • Phone: 763-772-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: