Individual
KENYATA TYESHIA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, CNP
Contact information
Practice address
324 E 35TH ST, MINNEAPOLIS, MN 55408-4580
(612) 827-7181
(612) 767-4545
Mailing address
6828 RUSSELL AVE S, RICHFIELD, MN 55423-2022
(763) 464-9711
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12819
MN
Other
Enumeration date
08/21/2025
Last updated
08/21/2025
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