# KAYA HEALTH CARE L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154754885
- **Authorized official:** ICEPHINE JOHNSON CNP BC (NURSE PRACTITIONER)
- **Authorized official phone:** (320) 420-0268

## Contact information

- **Practice address:** 26813 13TH AVE. S.E., SAINT CLOUD, MN 56304-8536
- **Practice address phone:** (320) 420-0268
- **Mailing address:** 26813 13TH AVE. S.E., SAINT CLOUD, MN 56304-8536
- **Mailing address phone:** (320) 420-0268

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 682820800022 | MN | Yes |

## Other

- **Enumeration date:** 08/16/2013
- **Last updated:** 08/16/2013