Provider Demographics
NPI:1548048531
Name:ROSE, KYLEE MICHELLE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:MICHELLE
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1304
Mailing Address - Country:US
Mailing Address - Phone:740-491-1727
Mailing Address - Fax:
Practice Address - Street 1:127 CUSTER AVE
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1304
Practice Address - Country:US
Practice Address - Phone:740-491-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide