Provider Demographics
NPI:1982433850
Name:GOSNELL, KAYLA JOAN (CNM)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:JOAN
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 134TH LN NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7112
Mailing Address - Country:US
Mailing Address - Phone:228-348-6623
Mailing Address - Fax:
Practice Address - Street 1:500 OSBORNE RD NE STE 150
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2770
Practice Address - Country:US
Practice Address - Phone:763-236-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN594367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife