Provider Demographics
NPI:1871079004
Name:DAULTON, KAYLA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:DAULTON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 490
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2773
Practice Address - Country:US
Practice Address - Phone:763-427-1137
Practice Address - Fax:763-427-4643
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2025-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant