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General NPI Number Information
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NPI Number | 1740099308
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Entity Type | Individual
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Provider Name | KENYATA MCCAIN
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3330 W 66TH ST
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City | EDINA
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State | MN
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Zip | 55435-5207
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Country | US
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Telephone | 612-358-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S 1ST ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55401-2037
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Country | US
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Telephone | 612-354-1456
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | MN
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