Provider Demographics
NPI:1740175553
Name:ROSS, KAYLIN MAURICE
Entity type:Individual
Prefix:
First Name:KAYLIN
Middle Name:MAURICE
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-2332
Mailing Address - Country:US
Mailing Address - Phone:513-596-0091
Mailing Address - Fax:
Practice Address - Street 1:1328 GREENUP ST APT 2
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3485
Practice Address - Country:US
Practice Address - Phone:513-596-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
KYR15620699172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver