Organization
KAYA HEALTH CARE L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ICEPHINE JOHNSON CNP BC (NURSE PRACTITIONER)
(320) 420-0268
Entity
Organization
Contact information
Practice address
26813 13TH AVE. S.E., SAINT CLOUD, MN 56304-8536
(320) 420-0268
Mailing address
26813 13TH AVE. S.E., SAINT CLOUD, MN 56304-8536
(320) 420-0268
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
682820800022
MN
Other
Enumeration date
08/16/2013
Last updated
08/16/2013
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