Healthcare Provider Details

I. General information

NPI: 1588207823
Provider Name (Legal Business Name): KAYLA MARIE CUMMINGS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA MARIE ACKERMAN

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 OAKDALE AVE N STE 303
ROBBINSDALE MN
55422-2977
US

IV. Provider business mailing address

3001 METRO DR STE 460
BLOOMINGTON MN
55425-1548
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-7700
  • Fax: 883-905-2110
Mailing address:
  • Phone: 651-999-7022
  • Fax: 651-999-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10327
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: