Healthcare Provider Details

I. General information

NPI: 1942115068
Provider Name (Legal Business Name): KYLEIGH KULKA MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LAKE HOLLINGSWORTH DR
LAKELAND FL
33801-5607
US

IV. Provider business mailing address

4072 PRAIRIE BEND LN
LAKELAND FL
33812-4184
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-4245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL7761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: