Provider Demographics
NPI:1184102329
Name:BACHAND, KAYLA LYNN (NP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:BACHAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 35TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5134
Mailing Address - Country:US
Mailing Address - Phone:320-760-8064
Mailing Address - Fax:
Practice Address - Street 1:4141 31ST AVE S STE 105
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8778
Practice Address - Country:US
Practice Address - Phone:701-314-4008
Practice Address - Fax:701-829-7247
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR39003363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health