Healthcare Provider Details

I. General information

NPI: 1932017597
Provider Name (Legal Business Name): KAYLA HOVLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103
US

IV. Provider business mailing address

4915 28TH AVE S APT 207
FARGO ND
58104-8466
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8000
  • Fax:
Mailing address:
  • Phone: 701-388-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR52714
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: