Healthcare Provider Details

I. General information

NPI: 1700708013
Provider Name (Legal Business Name): KYLAH BURKLEO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W OLD MAIN ST STE B
YELLVILLE AR
72687-8284
US

IV. Provider business mailing address

414 W OLD MAIN ST STE B
YELLVILLE AR
72687-8284
US

V. Phone/Fax

Practice location:
  • Phone: 870-701-5089
  • Fax: 870-277-0896
Mailing address:
  • Phone: 870-449-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA5137
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: