Provider Demographics
NPI:1699114975
Name:NATALA, NAKITA GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:NAKITA
Middle Name:GRACE
Last Name:NATALA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 AMERICAN BLVD E
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1232
Mailing Address - Country:US
Mailing Address - Phone:612-253-1111
Mailing Address - Fax:952-767-0782
Practice Address - Street 1:1801 AMERICAN BLVD E
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1232
Practice Address - Country:US
Practice Address - Phone:612-253-1111
Practice Address - Fax:952-767-0782
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011028532084P0800X
MN662702084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry