Healthcare Provider Details

I. General information

NPI: 1780365718
Provider Name (Legal Business Name): KAYLA LEE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11468 MARKETPLACE DR N STE 600-1135
CHAMPLIN MN
55316-3872
US

IV. Provider business mailing address

11468 MARKETPLACE DR N STE 600-1135
CHAMPLIN MN
55316-3872
US

V. Phone/Fax

Practice location:
  • Phone: 612-842-4405
  • Fax:
Mailing address:
  • Phone: 612-842-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: