Healthcare Provider Details

I. General information

NPI: 1780093195
Provider Name (Legal Business Name): KAYLEIGH HURSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEIGH AILA MINETTE FROST

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 1ST ST SUITE 400
DULUTH MN
55805-2297
US

IV. Provider business mailing address

1000 E 1ST ST SUITE 400
DULUTH MN
55805-2297
US

V. Phone/Fax

Practice location:
  • Phone: 218-625-2728
  • Fax: 218-722-6515
Mailing address:
  • Phone: 218-625-2728
  • Fax: 218-722-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: