Healthcare Provider Details

I. General information

NPI: 1538024153
Provider Name (Legal Business Name): MCKAYLA NICOLE NARVESON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 3RD ST
GAYLORD MN
55334-2297
US

IV. Provider business mailing address

310 S GLORIA DR
GREEN ISLE MN
55338-4510
US

V. Phone/Fax

Practice location:
  • Phone: 507-237-2933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127053
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: