Provider Demographics
NPI:1891336640
Name:NOWAK, KAYLA ELIZABETH (PMHNP-BC, MSN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELIZABETH
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:7400 METRO BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2324
Mailing Address - Country:US
Mailing Address - Phone:612-486-2956
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD STE 440
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2324
Practice Address - Country:US
Practice Address - Phone:612-486-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6940363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health