Provider Demographics
NPI:1720432768
Name:ADAMS, KAYLEE MICHAEL (DNP, APRN, NNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:KAYLEE
Middle Name:MICHAEL
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DNP, APRN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11107 ULYSSES ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4264
Mailing Address - Country:US
Mailing Address - Phone:763-333-7721
Mailing Address - Fax:763-333-7711
Practice Address - Street 1:11107 ULYSSES ST NE STE 100
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4264
Practice Address - Country:US
Practice Address - Phone:763-333-7721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4655363LN0005X
MNR 202369-0390200000X
MN4655363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program