Provider Demographics
NPI:1528640760
Name:KAVIRA HEALTH URGENT CARE LLC
Entity type:Organization
Organization Name:KAVIRA HEALTH URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-702-5420
Mailing Address - Street 1:1161 WAYZATA BLVD E # 162
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1935
Mailing Address - Country:US
Mailing Address - Phone:612-702-5420
Mailing Address - Fax:
Practice Address - Street 1:8530 W 35TH ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3853
Practice Address - Country:US
Practice Address - Phone:612-702-5420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1396272159OtherINDIVIDUAL NPI
MN1598173577OtherINDIVIDUAL NPI