Healthcare Provider Details

I. General information

NPI: 1427234475
Provider Name (Legal Business Name): KYLEEANN SOPHIA STEVENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2008
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 4TH ST NW
FARIBAULT MN
55021-5089
US

IV. Provider business mailing address

3200 LABORE RD STE 104
VADNAIS HEIGHTS MN
55110-5186
US

V. Phone/Fax

Practice location:
  • Phone: 507-384-6830
  • Fax: 651-431-7757
Mailing address:
  • Phone: 651-539-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number58689
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number58689
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: