Healthcare Provider Details

I. General information

NPI: 1962144295
Provider Name (Legal Business Name): MICAYLA FRANCES-KATE LESSARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GOLF COURSE RD
GRAND RAPIDS MN
55744-8648
US

IV. Provider business mailing address

711 SE 2ND AVE
GRAND RAPIDS MN
55744-3907
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3401
  • Fax:
Mailing address:
  • Phone: 218-259-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79098
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: