Provider Demographics
NPI:1285171579
Name:PINEDA, KAYLA (NP-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PINEDA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1927
Mailing Address - Country:US
Mailing Address - Phone:507-831-2223
Mailing Address - Fax:507-831-0135
Practice Address - Street 1:591 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1927
Practice Address - Country:US
Practice Address - Phone:507-831-2223
Practice Address - Fax:507-831-0135
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily