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General NPI Number Information
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NPI Number | 1164281028
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Entity Type | Individual
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Provider Name | KAYLA NACHBAR
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Gender | Female
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 1406 6TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1901
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Country | US
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Telephone | 320-251-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 120TH CIR NE UNIT F
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City | BLAINE
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State | MN
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Zip | 55449-2408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15500
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License Number State | MN
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