Healthcare Provider Details

I. General information

NPI: 1215859863
Provider Name (Legal Business Name): KAITLYN MARIE CUMMINGS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 YORK AVENE SOUTH
EDINA MN
55435
US

IV. Provider business mailing address

6905 YORK AVE S
EDINA MN
55435-2517
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14453
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: