Healthcare Provider Details

I. General information

NPI: 1285171579
Provider Name (Legal Business Name): KAYLA PINEDA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 2ND AVE N
WINDOM MN
56101-1927
US

IV. Provider business mailing address

591 2ND AVE N
WINDOM MN
56101-1927
US

V. Phone/Fax

Practice location:
  • Phone: 507-831-2223
  • Fax: 507-831-0135
Mailing address:
  • Phone: 507-831-2223
  • Fax: 507-831-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP 4980
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: