Provider Demographics
NPI:1770271355
Name:RUPE, KYLIE CIERRA
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:CIERRA
Last Name:RUPE
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 1:172 KERR RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9568
Mailing Address - Country:US
Mailing Address - Phone:740-645-5184
Mailing Address - Fax:
Practice Address - Street 1:172 KERR RD
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9568
Practice Address - Country:US
Practice Address - Phone:740-645-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant