Provider Demographics
NPI:1316746001
Name:BRULPORT, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BRULPORT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BROOKBURN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1431
Mailing Address - Country:US
Mailing Address - Phone:937-638-6380
Mailing Address - Fax:
Practice Address - Street 1:405 BROOKBURN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1431
Practice Address - Country:US
Practice Address - Phone:937-638-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide