Healthcare Provider Details

I. General information

NPI: 1417659426
Provider Name (Legal Business Name): KAYLA ANN FUSSY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA ANN OLSON

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13060 ISLE DR
BAXTER MN
56425-8331
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-2880
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82739
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: