Provider Demographics
NPI:1992236681
Name:HARRIS, KAYLA ANN (DO)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:ANN
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1110 YANKEE DOODLE RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2092
Mailing Address - Country:US
Mailing Address - Phone:651-454-3970
Mailing Address - Fax:
Practice Address - Street 1:1110 YANKEE DOODLE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2092
Practice Address - Country:US
Practice Address - Phone:651-454-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN64236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine