Healthcare Provider Details

I. General information

NPI: 1013849132
Provider Name (Legal Business Name): KAYLA C FUQUA CO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SMITH AVE N STE 101
SAINT PAUL MN
55102-2420
US

IV. Provider business mailing address

280 SMITH AVE N STE 101
SAINT PAUL MN
55102-2420
US

V. Phone/Fax

Practice location:
  • Phone: 651-291-9000
  • Fax: 651-291-8894
Mailing address:
  • Phone: 651-291-9000
  • Fax: 651-291-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: