Provider Demographics
NPI:1154754885
Name:KAYA HEALTH CARE L.L.C.
Entity type:Organization
Organization Name:KAYA HEALTH CARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ICEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNP BC
Authorized Official - Phone:320-420-0268
Mailing Address - Street 1:26813 13TH AVE. S.E.
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-8536
Mailing Address - Country:US
Mailing Address - Phone:320-420-0268
Mailing Address - Fax:
Practice Address - Street 1:26813 13TH AVE. S.E.
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-8536
Practice Address - Country:US
Practice Address - Phone:320-420-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN682820800022363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty